Care Professional Employment

Application Confidential
Thank you for your interest in Home Instead. As part of our process and to ensure we
adhere to our statutory requirements, we require all sections of this application form to be
fully completed. If you need more space, please use a separate piece of paper.
If you have any issues completing this form, please make one of our team aware and they
will be happy to help.
Vacancy applied for:

Please indicate where you heard about the vacancy:

PERSONAL DETAILS
First Name(s): Damilola Surname: Dawodu

Title: Ms Former
Name(s):

Current Address: 16 Roseberry Avenue Email Damilolamiuk@gmail.com

Thornton Heath London Address:
Telephone
Number: +44 7769 498213
Mobile
Number:
Postcode: CR7 8PT N.I.
Number
Do you hold a full current driving licence? No
Do you have access to reliable transport? YES Yes
Have you worked for Home Instead before? NO No
If yes, please provide details:

EDUCATION AND TRAINING

Please provide details of education and training
Date (MM/YYYY) Name and Address of Details of Examination / Results
Education Establishment Awards
08 / 2014 Olabisi Onobanjo University, Bachelor of Science in Second Class
Nigeria Accounting Upper – 2.1

Each Home Instead® franchise office is independently owned and operated. © 2021 Home Instead Limited
Care Professionals Application Form 200122
 EDUCATION AND TRAINING (Continued)
Date (MM/YYYY) Name and Address of Details of Examination / Results
Education Establishment Awards

EMPLOYMENT HISTORY
Please detail a full employment history in chronological order since leaving secondary
education, starting with your current or most recent employer. Please provide details of all
full and part time work as well as particulars of all paid and unpaid work experience e.g.
commercial experience, raising a family, youth work, voluntary work or periods when you
were not employed.
PLEASE PROVIDE AN EXPLANATION OF ANY GAPS IN EMPLOYMENT WHICH EXCEED MORE
THAN ONE MONTH
Dates (MM/YYYY) Name and Address of Job Title and Reason for Salary
From To Employer Duties Leaving

Each Home Instead® franchise office is independently owned and operated. © 2021 Home Instead Limited
Care Professionals Application Form 200122
 EMPLOYMENT HISTORY (Continued)
Dates (MM/YYYY) Name and Address of Job Title and Reason for Salary
From To Employer Duties Leaving

Each Home Instead® franchise office is independently owned and operated. © 2021 Home Instead Limited
Care Professionals Application Form 200122
 ABOUT YOU
Please provide details of your skills and experience, both personal and professional, which
you could bring to the Care Professional role.

Please provide full details of your hobbies and interests so we can match your interests
Each Home Instead® franchise office is independently owned and operated. © 2021 Home Instead Limited
Care Professionals Application Form 200122
 with those of the client

Each Home Instead® franchise office is independently owned and operated. © 2021 Home Instead Limited
Care Professionals Application Form 200122
REFERENCES
Home Instead prides itself on the quality of our Care Professionals and therefore, as part
of the recruitment process, we ask for a minimum of four references, two personal (not
relatives) and two professional, one of which must be your present or most recent
employer.
Please note applications cannot be progressed unless details of four referees are provided.
We will not request for references until after you have attended an interview.

PERSONAL REFERENCES
Referee’s Name Contact Details Best Time Relationshi Number of
(Email / Phone Number) to Contact p to You Years
Known
1.

2.

PROFESSIONAL REFERENCES
Referee’s Name Company Name and Contact Details Relationshi
Address (Email / Phone Number) p to You
1.

2.

AVAILABILITY

Please let us know when you would be available to work. Please note this does not
guarantee that we can provide these hours.

Day Anytim Mornin Lunchtim Afternoo Evening Overnigh Live In

e g e n s t
Monday

Tuesday

Wednesda
y
Thursday

Friday

Saturday

Sunday

Each Home Instead® franchise office is independently owned and operated. © 2021 Home Instead Limited
Care Professionals Application Form 200122
CONVICTIONS
The position you have applied for is exempt from the provision of section 4 of the
Rehabilitation of Offenders Act 1974, which means that you are not entitled by law to
withhold information about any civil or criminal convictions which for other purposes are
“spent” under the provisions of the Act.
If you are successful with this application, any failure to disclose such information could
result in withdrawal of offer, dismissal or disciplinary action. Any information given will be
completely confidential and will be considered only in relation to this application.
In view of this, please answer the following questions:

Have you any previous civil or criminal convictions, cautions, reprimands, Yes / No
final warnings or any pending prosecutions?

If yes, please detail offence(s) including date(s) and sentence(s) where

relevant, on a separate sheet.

I can confirm that I am not barred from working with vulnerable adults or Yes / No
children or subject to sanctions imposed by a regulatory body.

RIGHT TO WORK IN THE UK

Do you need a permit in order to work in the UK? Yes / No

Will you be working in England?

Yes / No (circle correct answer)

If yes, please read the information below regarding Covid-19 vaccination

A client of a Home Instead franchised office may legitimately request their care
professional to be vaccinated. While it is not a condition of employment in England, Wales,
Scotland or Northern Ireland that you are fully vaccinated against COVID-19 or are exempt
from vaccination in accordance with the applicable public health rules, we are collecting
this information in order to that we can match you accordingly with future clients who
might make such a request. In addition we may ask in future whether you have had any
booster vaccinations or subsequent courses of a COVID-19 vaccine as recommended by the
UK Health Security Agency (or any other relevant body).

Please confirm your Covid-19 vaccination status:

Yes, I am fully vaccinated. Yes / No

No, I am not vaccinated. Yes / No

I am medically exempt from vaccination. Yes / No

Each Home Instead® franchise office is independently owned and operated. © 2021 Home Instead Limited
Care Professionals Application Form 200122
DECLARATION

I certify that the answers given by me to the foregoing questions and the statements made
by me are complete and true to the best of my knowledge and belief. I understand that
any false information, omissions or misrepresentations of facts called for in this
application may result in rejection of my application or discharge at any time during my
employment.

In line with the Data Protection Promise provided, I am happy for this information to be
held in a secure place and used in processing my application.

I understand that any offer of employment will be subject to the receipt of evidence of the
right to work in the UK, a satisfactory enhanced disclosure and a minimum of 4
satisfactory references.

Signature: ______________________________________ Date: _____________

Thank you for taking the time to complete this application form.

Abercare Limited trading as Home Instead Croydon and Dulwich

Registered Office Address • Chester House, Lloyd Drive, Cheshire Oak Business Park, Ellesmere Port, Cheshire,
United Kingdom. CH65 9HQ
Registered in {England and Wales Company Registration No: 10122385
Office address: 67 Windmill Road, Croydon, CR0 2XR
Telephone: 0208 404 4444 • Website: www.homeinstead.co.uk/croydondulwich

Each Home Instead® franchise office is independently owned and operated. © 2021 Home Instead Limited
Care Professionals Application Form 200122
 Each Home Instead® franchise office is independently owned and operated. © 2021 Home Instead Limited
Care Professionals Application Form 200122