CLIACare Job Application

Thank you for applying for a role with CLIA Care. Please fill out the job application below, with as much detail as possible. We will be in touch shortly.

Job Information
Personal Details
Name *
Address *
Phone *
Additional Information
Criminal Record Declaration
The nature of the work you are applying for is exempt from the provisions of the Rehabilitation of Offenders Act 1974. If you are applying for a post involving access to persons in receipt of care services, your offer of employment will be subject to a satisfactory enhanced Disclosure and Barring check. It is therefore a requirement that all previous convictions are declared, even those which would otherwise be regarded as ‘spent’. (Any such information will be treated confidentially). Please read the above carefully and then answer the following questions:
Education, Training, Qualifications and Current Learning
Employment History
Start Date *
Start Date
End Date
End Date
Employer Address *
Employer Address
Employer Phone Number *
Employer Phone Number
Please include job title, start dates, end dates, employers name and address, your duties/responsibilities and your reason for leaving.
Relevant Experience
Please use this section to state how your skills, experience and training would enable you to meet the requirements of the role for which you are applying.
Please provide the names and contact details of referees: the first referee must be your present or most recent employer, if there is less than two years between both of these then please provide a further reference. We will not contact any referee without your permission or until an offer of employment has been accepted. Also, if you have previously been employed in a position which involved working with vulnerable adults or children for more than three months then one of the references you provide must be from this agency/employer. (In accordance with the Health and Social Care Act 2008). Personal references such as relatives, friends, neighbours etc ARE NOT acceptable as referees
Reference 1 Name *
Reference 1 Name
Reference 1 Address *
Reference 1 Address
Reference 1 Phone Number *
Reference 1 Phone Number
Reference 2 Name *
Reference 2 Name
Reference 2 Address *
Reference 2 Address
Reference 2 Phone Number *
Reference 2 Phone Number
Application Declaration
1. The information in this form is true and complete. I agree that any deliberate omissions, falsification or misrepresentation on this form will be grounds for rejecting this application or subsequent dismissal if employed by the organisation. This equally applies to any medical questionnaires I may complete. 2. I confirm that I have not been subject to any cautions or convictions (other than those given above), investigation, disciplinary action, or enquiry into adult/child protection matters or inappropriate behaviour, and that the information I have given in the Criminal Record declaration section is to the best of my knowledge correct.