Email: enquiries@edenrosecarerecruitment.co.uk
Phone: 0333 404 8926
Application Form

Page 7

APPLICATION FORM - CARE WORKERS

Have you had surgery in hospital in the past 2 years?
Are you a hospital outpatient receiving treatment?
If so – please give details:
How many days have you taken in sick leave in the past 2 years?
Have you been inoculated for any of the following?

Tuberculosis BCG:     Yes     No
Hepatitis B:     Yes     No
Rubella:     Yes     No
Tetanus:    Yes     No
Flu:    Yes     No
The Company may wish you to have a course of vaccinations against Hepatitis B and the Manager will discuss this with you. I certify that the information I have provided is accurate and that I am in good health and fit to carry out the duties as described in the Care Worker’s job description.
I understand that any information i give will be treated in the strictest confidence. Any information that i give that details any offences – will not jeopardize my application.

I understand I will have to sign a document to confirm all of the information I have entered here.





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RECOMMENDATIONS

If you recommend a friend we will reward you with a £50.00 John Lewis voucher or we can make a donation to your favourite charity.

Address

41 Blenheim Square,
North Weald Bassett,
Epping

Contact

Email: enquiries@edenrosecarerecruitment.co.uk
Phone: 0333 404 8926

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