Recruitment | MaryRuth

Join Our Team: Explore Exciting Opportunities at Mary Ruth Care.

Discover fulfilling career opportunities at Mary Ruth through our inclusive recruitment process, where your skills and dedication are valued. Fill Out the form or download the forms below.

Home Care Application Form

Health Declaration: Form1-219

Home Care Application Form

Step 1 of 6

16%

Personal Details

Title

First Name(Required)

Last Name(Required)

Have you ever been known by another name?

Yes

Previous Name

Date Name Changed (DD/MM/YYYY)

DD slash MM slash YYYY

Date of Birth (DD/MM/YYYY)(Required)

DD slash MM slash YYYY

Place of Birth(Required)

Nationality(Required)

National Insurance Number(Required)

Do you hold a current UK driving licence?

Yes

Endorsements

Do you have regular use of a car?

Yes

Contact Details

Permanent address(Required)

Postcode(Required)

Home Telephone(Required)

Mobile(Required)

Email(Required)

Next of Kin

Next of Kin(Required)

Address(Required)

Home Telephone(Required)

Mobile(Required)

Non EC Nationals only

Are you a non EU National?(Required)

Yes

Entry Date into UK (DD/MM/YYYY)(Required)

MM slash DD slash YYYY

Do you require a work permit?(Required)

Yes

Work Permit Type

Work Permit Expiry Date (DD/MM/YYYY)

MM slash DD slash YYYY

Professional Qualifications (includes Social work, Counselling, NVQ etc)

Qualification 1

Qualification

Grade

Examination Body

Date (DD/MM/YYYY)

DD slash MM slash YYYY

Qualification 2

Qualification

Grade

Examination Body

Date (DD/MM/YYYY)

DD slash MM slash YYYY

Qualification 3

Qualification

Grade

Examination Body

Date (DD/MM/YYYY)

DD slash MM slash YYYY

Qualification 4

Qualification

Grade

Examination Body

Date (DD/MM/YYYY)

DD slash MM slash YYYY

Training Undertaken (includes Manual Handling, first aid, food hygiene etc)

Course 1

Date (DD/MM/YYYY)

DD slash MM slash YYYY

Course 2

Date (DD/MM/YYYY)

DD slash MM slash YYYY

Course 3

Date (DD/MM/YYYY)

DD slash MM slash YYYY

Course 4

Date (DD/MM/YYYY)

DD slash MM slash YYYY

Education (Including Current Studies)

Education 1

Name of school college/university

Subject

Grade

Date (DD/MM/YYYY)

DD slash MM slash YYYY

Education 2

Name of school college/university

Subject

Grade

Date (DD/MM/YYYY)

DD slash MM slash YYYY

Education 3

Name of school college/university

Subject

Grade

Date (DD/MM/YYYY)

DD slash MM slash YYYY

Education 4

Name of school college/university

Subject

Grade

Date (DD/MM/YYYY)

DD slash MM slash YYYY

Previous Employment (Where applicable please give details of your last 3 jobs:)

Have you ever been the subject of complaint, dismissal or disciplinary action?

Yes

Employment 1

Job Title

Date From (DD/MM/YYYY)

DD slash MM slash YYYY

Date To (DD/MM/YYYY)

DD slash MM slash YYYY

Company Name

Contact Name

Telephone Number

Address

Main Duties

Reason for leaving

Employment 2

Job Title

Date From (DD/MM/YYYY)

DD slash MM slash YYYY

Date To (DD/MM/YYYY)

DD slash MM slash YYYY

Company Name

Contact Name

Telephone Number

Address

Main Duties

Reason for leaving

Employment 3

Job Title

Date From (DD/MM/YYYY)

DD slash MM slash YYYY

Date To (DD/MM/YYYY)

DD slash MM slash YYYY

Company Name

Contact Name

Telephone Number

Address

Main Duties

Reason for leaving

Employment 4

Job Title

Date From (DD/MM/YYYY)

DD slash MM slash YYYY

Date To (DD/MM/YYYY)

DD slash MM slash YYYY

Company Name

Contact Name

Telephone Number

Address

Main Duties

Reason for leaving

Employment 5

Job Title

Date From (DD/MM/YYYY)

DD slash MM slash YYYY

Date To (DD/MM/YYYY)

DD slash MM slash YYYY

Company Name

Contact Name

Telephone Number

Address

Main Duties

Reason for leaving

Employment 6

Job Title

Date From (DD/MM/YYYY)

DD slash MM slash YYYY

Date To (DD/MM/YYYY)

DD slash MM slash YYYY

Company Name

Contact Name

Telephone Number

Address

Main Duties

Reason for leaving

References

We will be taking up references covering a minimum of 3 years. One reference will normally be from your previous/current employer. College/university leavers should give the name of their lecturers/tutors/professors. Please note, friends and relatives do not qualify as suitable referees. Please provide referees below, including your most recent employer, covering a 3 year period

Reference 1

Date From (DD/MM/YYYY)

DD slash MM slash YYYY

Date To (DD/MM/YYYY)

DD slash MM slash YYYY

Company Name

Contact Name

Telephone Number

In what capacity is this person known to you? (e.g. previous employer, college tutor)

Reference 2

Date From (DD/MM/YYYY)

DD slash MM slash YYYY

Date To (DD/MM/YYYY)

DD slash MM slash YYYY

Company Name

Contact Name

Telephone Number

In what capacity is this person known to you? (e.g. previous employer, college tutor)

Reference 3

Date From (DD/MM/YYYY)

DD slash MM slash YYYY

Date To (DD/MM/YYYY)

DD slash MM slash YYYY

Company Name

Contact Name

Telephone Number

In what capacity is this person known to you? (e.g. previous employer, college tutor)

More info

Where did you hear about us?

Supporting Documents

Max. file size: 2 MB.

Supporting Documents

Max. file size: 2 MB.

Supporting Documents

Max. file size: 2 MB.

Supporting Documents

Max. file size: 2 MB.

0114 2581983

Join Our Team: Explore Exciting Opportunities at Mary Ruth Care.

Home Care Application Form

Personal Details

Contact Details

Next of Kin

Non EC Nationals only

Professional Qualifications (includes Social work, Counselling, NVQ etc)

Qualification 1

Qualification 2

Qualification 3

Qualification 4

Training Undertaken (includes Manual Handling, first aid, food hygiene etc)

Course 1

Course 2

Course 3

Course 4

Education (Including Current Studies)

Education 1

Education 2

Education 3

Education 4

Previous Employment (Where applicable please give details of your last 3 jobs:)

Employment 1

Employment 2

Employment 3

Employment 4

Employment 5

Employment 6

References

Reference 1

Reference 2

Reference 3

More info

Services

Links

Quick Contacts