Employment History & Reference Form

Employment history
We require employment history from the last 10 years. This need to be in a date format of MM/YYYY. If there are
gaps in your employment, for example periods of unemployment, voluntary work or study, you will need to log and
detail. We also need your reason for leaving each role.

Employment details
Start date Leave date Company / Organisation Job title / role Reason for leaving
(MM/YYYY) (MM/YYYY) (Eg: Support worker / student /
stay at home parent/carer)

References
Have you previously worked within the Health & Social Care sector?
If yes, please provide us with reference details for your 2 most recent employers within Health & Social Care using
the form below. Please note it does not matter how long ago you worked for these employers, we are required to
apply for these references.

If no, then for those applying for a role within England, there is no need to provide us with any reference
information as we do not require it at this stage. (For those applying for a role in Wales & Scotland please provide
reference details for your 2 most recent employers or please provide reference details for your most recent
employer and most recent care employer)

NB. We can only accept official contact details i.e. landline number and company email address. Mobile numbers, personal
email addresses and residential addresses will not be accepted.

REFERENCE 1 REFERENCE 2
PRESENT OR MOST RECENT EMPLOYER SECOND MOST RECENT EMPLOYER
Company Company
name: name:
Manager Manager
name: name:
Telephone Telephone
number: number:
(landline) (landline)
Company Company
email email
address: address: