Application Form

    Due to the nature of the work, our service hours are 07:00 – 22:00. Carer are required to work some evenings and alternate week
    Registered Nurses & Social Workers only
    Please provide a FULL continuous employment history. Where the previous employment is NOT Continuous and there are gaps in employment, please provide a full explanation in the section provided below. (Current / Most Recent Employer First)

    Position Employer From To Reason for Leaving
    Please provide dates and reasons for any gaps in employment:
    EDUCATION & TRAINING (Secondary Education and above)
    From To Name and address of School, College etc Course, Qualification, Results
    Please provide details of at least two professional referees we can contact, one of which must be your current / most recent employer.

    Reference 1
    Reference 2
    Reference 3
    European Union, Swiss and EEA nationals have an automatic right to work in the UK. Some restrictions apply to Bulgarian and Romanian citizens. Some visa holders cannot take temporary employment in the UK.

    Have you ever been permanently or temporarily placed on a Sex Offenders register, the Protection of Vulnerable Adults or Protection of Children lists or the register of persons banned from working with children or vulnerable adults kept by ISA or the Disclosure & Barring Service, or similar?

    All applicants must disclose details of any spent or unspent criminal convictions or police cautions, reprimands or final warnings they may have received in the UK or abroad. This is because jobs within this organisation are covered by the Rehabilitation of Offenders Act 1974 (Exceptions) Orders 1975 (Amended) 1986.

    You are required to include information about convictions which may be otherwise considered ‘spent’, however you may omit details of anything which (in line with current guidance) will be filtered out from a Disclosure & Barring Service (DBS) enhanced disclosure. The information you provide will be treated as strictly confidential and will only be considered where it seems reasonably relevant to the appointment for which you are applying.

    Disclosure of any information does not necessarily mean that you will not be considered for appointment. GoodKnight Home Care Ltd will take account of (among other things) the ACAS Code of Guidance. A main consideration will be whether the offence is one which would make an applicant unsuitable to work with children or vulnerable adults and the type of work to be done. However please note that we may be contractually obliged to reveal the content of disclosures to customers and by signing this application form you give your consent for us to do this and for us to continue with yearly updates.

    In accordance with care sector regulations, if you do not have suitable personal registration with the DBS Update Service, you will need a new ‘enhanced’ DBS disclosure before you can work for GoodKnight Home Care; we will help you obtain this. Once received you must forward it (the original) to us without delay; it will be copied and returned to you. You also need to show us the results of any checks of the courts and police records from other countries in which you have lived. The information you declare below will be compared with the results of these disclosures. It will be necessary for disclosures/checks to be obtained at your own expense. DBS disclosures and Update Service checks will include checks of the lists of persons banned from working with children and vulnerable adults.

    If you prefer, you may provide information in a separate letter in a sealed envelope marked "Private & Confidential", addressed to your interviewer or the Registered Manager, or in an email to: Please ensure you get written acknowledgment from us of any such correspondence.

    If yes, please provide details below:

    Information about Convictions, etc. Date Outcome


    GoodKnight Home Care is required to automatically enrol you into the company’s pension scheme after 3 months employment. More information will be provided to you if you are successful at interview.

    You will have the option to “opt-out” of the scheme, but this will have to be communicated by you directly by the pension company.

    You cannot be excluded from auto-enrolment.

    Tell us why you have applied for the post, your skills and experience. Include interests and hobbies.

    As this post is exempt from the provisions of the Rehabilitation of Offenders Act 1974 (Exemptions) Order 1975, I hereby undertake to advise Good Knight Homecare Ltd of any criminal offence (including motoring offences) which I may be convicted of during my employment/registration with Good Knight Home Care Ltd.

    Data Protection

    I understand that if I am appointed the information I have supplied on this form and elsewhere, including information that may be considered sensitive and personal, may be processed by and stored on a computer, and kept in my personal records. I understand that the information may be used for employment checks, equality monitoring and statistical purposes and may be audited by representatives of the Care Quality Commission, the NHS and others with a regulatory or contractual right to do so. I hereby give my consent for my data to be used for these purposes.

    Employment Checks

    I give my consent for vetting and compliance checks to be performed on me before and periodically after recruitment and acknowledge that any failure to provide accurate information may result in my application not being taken forward or, following recruitment, possible disciplinary action or removal from the agency’s register of temporary workers. I understand that customers and care sector regulators may be given access to documents used in Employment Checks, including references and qualification certificates

    Confidentiality Statement

    During the course of your employment with Good Knight Home Care Ltd you may acquire or have access to confidential information which must not be disclosed to any other person, other than in the legitimate pursuit of your duties, this condition applies during your employment/registration with Good knight Homecare Ltd and after you leave the company.

    Confidential information includes all information relating to the business of Good Knight Homecare Ltd and its staff, its service users and their families, and its clients and their employees and patients/ service users. Within the NHS, confidentiality is governed by the Caldicott Protocols.

    The Data Protection Act 1998 regulates the use of all personal information including electronic and paper records of identifiable individuals, including service users and their family members, agency workers and employees, referees and complainants and the patients/service users and employees of our clients.

    If you are found to have used or passed on, other than in the proper pursuit of your duties, any information you have gleaned whilst in the employment of PNL you may face disciplinary action, removal from the staff register and/or prosecution.

    Working Times Regulation

    EU employment safety rules adopted into UK law govern the maximum length of the working week. The limit is (an average of) 48 hours per week, however UK workers can choose to opt-out of these regulations. You are under no obligation to work over and above the 48 hours per week, but if you wish to do so you must sign below to confirm that you have read and understood this information and to indicate your preference by ticking the appropriate box. If you change your mind, you must give Good Knight Homecare Ltd 8 weeks notice in writing of your decision to opt it or out of these regulations.

    I understand that I am bound by a duty of confidentiality and agree to adhere to the conditions within this Statement.

    I understand my personal responsibilities to comply with my duty of confidentiality, the Data Protection Act 1998 and all other relevant legislation.

    I declare that the information I have provided in this Application Form is a complete and true statement.

    I understand that any offer of appointment and subsequent employment is conditional on this declaration and if my application is incomplete, untrue or inaccurate, then GoodKnight Home Care Ltd shall be entitled to withdraw any offer of appointment or terminate any contract of employment.


    GoodKnight Home Care Ltd aims to recruit and select suitably and appropriately qualified applicants solely on the grounds of merit and encouraging diversity amongst the workforce.

    No applicant will be discriminated against regardless of their age, colour, disability, ethnicity, gender or gender identity, race, religion or belief and / or sexual orientation or if you do not wish to complete this form. It will not be considered during the recruitment and selection process.

    Please complete by choosing the most appropriate answer.

    The Equality Act 2010 defines disability as "a) if a person has a physical or mental impairment, and b) the
    impairment has a substantial and long-term adverse effect on the person’s ability to carry out normal day-to-day