Applicant Details

Qualifications and Training

Schools Attended Qualification Gained Year Obtained
Colleges Attended Qualification Gained Year Obtained

Employment History

Date from Date to Job Title and Duties Name and address of employer Reason for leaving

Please can you give reasons and dates for any gaps in employment.


Please provide details of two referees who can provide information relating to your competency for this role, one of whom must be your current or latest employer. If you are a student, please give an academic referee. As this is an application for a post which requires unsupervised access to vulnerable adults, we reserve the right to approach any past employer for a reference.

General Comments


Because of the nature of the work for which you are applying, this post is exempt from the provisions of Section 4(2) of the Rehabilitation of Offenders Act 1974, by virtue of the Exceptions Order 1975 as amended by the Exceptions (Amendment) Order 1986, which means that convictions that are spent under the terms of the Rehabilitation of Offenders Act 1974 must be disclosed, and will be taken into account in deciding whether to make an appointment. Any information will be completely confidential and will be considered only in relation to this application.

In addition, you are required to submit to a Disclosure and Barring Service (DBS) check. Any standard or enhanced disclosure made by the DBS will remain strictly confidential.


Because this position involves the care of vulnerable adults’ employment is dependent on the following:

  1. Your consent to obtaining a standard/enhanced disclosure certificate from the Disclosure and Barring service or an approved umbrella body
  2. Such disclosure being acceptable to us
  3. Proof of identity – birth or marriage certificate (where appropriate) and passport (if available).
  4. Two satisfactory written references.
  5. That you will supply a photograph of yourself for retention in your records.
  6. Proof of status to work in the UK (where appropriate).


Home Focus pride themselves on maintaining and adhering to guidelines and legislations with regard to the recruitment of their staff.

As such – all employees and prospective employees are requested to declare their participation in any known disciplinarians / allegations of abuse that have been made against them.

Employees and prospective employees should be aware that Disclosure and Barring Service checks are carried out following an initial offer of employment and status checks will be done at regular intervals thereafter.

An offer of employment may be withdrawn if it transpires that information regarding the above was undisclosed at the time of offer of employment.


All offers of employment will be subject to references being received and a suitable check being completed with the Disclosure and Barring Service.

Before you submit the application form please ensure you have completed the Question of Care Survey as your application will not be processed without this being completed

If you do not hear from us within 14 working days of your application then please accept this as notification that your application was unsuccessful on this occasion. We ask that you wait 6 months before re-apply.


  • I confirm that the above information is complete and correct and that any untrue or misleading information will give my employer the right to terminate any employment contract offered.
  • Should we require further information and wish to contact your doctor with a view to obtaining a medical report, the law requires us to inform you of our intention and obtain your permission prior to contacting your doctor. I agree that the organisation reserves the right to require me to undergo a medical examination. In addition, I agree that this information will be retained in my personnel file during employment and for up to six years thereafter and understand that information will be processed in accordance with the Data Protection Act.
  • I agree that should I be successful in this application I will apply to the Disclosure and Barring Service for an enhanced disclosure. I agree to sign up to, maintain and pay for my continued registration with the DBS update service whilst in this service’s employ. I understand that should I fail to do so or should the disclosure not be to the satisfaction of the company any offer of employment may be withdrawn or my employment terminated.
  • I give ongoing consent to Home Focus to carry out status checks with the DBS, as they deem necessary, if I am successful in this application (whilst in Home Focus’ employ).

User of the Care Management System from QCS