Application Form For Ivers Care Services

Personal Details

Referred by?

Do you require a work permit to work in the UK? *

Do you have at least 6 months previous experience? *

Please confirm you are aged 18 years or over *

Are you driver ?


Name and Location of establishment Subjects Passed and type of examination Grade (full or part time course)


Present or most recent Employment

Previous Employment (Most recent first)

Add more previous employment

References will be sought for successful candidates only. As indicated on the application form two referees are required. If you are currently employed, one should be the name of your current employer and the second from appropriate individuals who can ensure the integrity and good character of yourself. Friends and family members will not be accepted.

In the event that you have only worked as a volunteer, references will be required from the two most recent bodies for whom you have worked.

Other Information

Please give any additional information to support your application.

Disclosure Information

Because of the nature of the work concerned, this post is exempt from the provision of section 4 (2) of the Rehabilitation of Offenders Act 1974. You are not entitled to withhold information about convictions which for other purposes are ‘spent’ under the provisions of the Act. Any such information given will be completely confidential and will be considered only in relation to your registration. In order to fulfil the requirements of the above mentioned Act would you please complete the following:

NB Having a criminal conviction will not bar you from working with us. This will depend on the nature of the position and the circumstances and background of your offence. In the event of employment, any failure to disclose such convictions could result in dismissal or disciplinary action by Ivers Care Services.


2a. Details of the proceedings:

2b. Date of proceedings

2c. Country and name and address of licensing or regulatory body:

2d. Have you ever been disqualified from practicing?

If YES, Please give details:

If YES, Please give details:

Equal Opportunities (Optional)

Ivers Care Services are taking steps to ensure the implementation of its Equal Opportunities Policy. This section is intended to monitor the effectiveness of our policy and will play no part in our recruitment process. It is used purely for monitoring purposes and completion of this section is optional.

Completing Your Application

I certify that I have read the document fully and that all the above information is correct. I understand that false declaration may lead to refusal of this application.

I understand and agree to Ivers Care Services disclosing this information to their clients for the purpose of finding me assignments. By submitting the application, I agree I have read and understand the Privacy Policy.

I understand that registration is subject to an occupational health assessment, references and Disclosure and Barring service disclosure (DBS).