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Employment Questionnaire

The information you supply on this Employment Questionnaire and any other additional material you include is what we will use to complete our Pre-Employment checks.

Please complete all sections. If you have nothing to put in the space, please write N/A rather than leave it blank.

The answers you provide will be treated in strictest confidence and will not be seen by anyone except our HR Department, our Care Home Management Team and the relevant Inspection Authorities. No information will be disclosed to any third party without your permission.

    Role Details

    Please select from the drop-down boxes below which role you are applying for and the home where you will be based.

    Personal Details

    Please provide your contact details below. We will use this information to create your employee profile.

    Date Of Birth

    Training and Qualifications

    Please list any relevant training or qualifications you currently hold.

    Click here to add another training/qualification

    Employment History

    Please include any previous employment both paid and unpaid, starting with the most recent first. If you have worked in a Care Home before, please include your reason for leaving.

    Click here to add another employment history

    Medical History

    Please answer the questions below about your health and medical history. We ask these questions to help us understand if we need to make any reasonable adjustments, for example this might include an adapted work environment, flexibility during the working day or extra resources to help perform your job role.

    Criminal Record Declaration

    You have been asked to complete these questions because the role you have applied for is exempt from the Rehabilitation of Offenders Act 1974. The information disclosed will be treated in the strictest of confidence and will only be disclosed to the Home Management team and/or the HR Team.


    Please give the names and contact details of two referees, one of which should be a professional reference, ideally your most recent employer. A professional reference can also include a teacher, lecturer or landlord.

    Colleague Referral

    If you have been referred to this position by a current member of staff, please enter their details in the fields below as you may be eligible for our Recommend a Friend bonus scheme.


    I understand that my employment is conditionally based upon a satisfactory Disclosure Certificate, medical suitability, and a right to work in the UK.

    I agree that Christadelphian Care Homes can create and maintain computer records of my personal data and that this will be processed and stored in accordance with the General Data Protection Regulations (GDPR)

    I certify that the answers to the above questions are correct to the best of my knowledge and belief. I understand that if I have withheld information, this may adversely affect efforts to place me in suitable employment. I understand that any omissions or false statements may disqualify me from employment or lead to dismissal