Revolution Caring 24/7

1INFORMATION

2EXPERIENCED IN

3MEMBER DECLARATION

4HEALTH QUESTIONNAIRE

5WORK AGREEMENT

Do you have ‘Right to Work’ in the UK?(Required)

Yes

How much experience do you have?(Required)

No experience

Up to 1 year

1-3 years

3-5 years

5 – 10 years

More that 10 years

Mr/ Mrs/ Ms/ Miss/ Surname(Required)

Full Names(Required)

AKA(Required)

Date of birth(Required)

Tel No(Required)

Postal address(Required)

Passport Number(Required)

Date of issue(Required)

NI Number(Required)

Last DBS Number(Required)

Update Service ID Number (if any)

How did you get to know about Revolution Care?(Required)

Next of kin name & full contact details:(Required)

How are you related?(Required)

CERTIFICATES RELATED TO CAREWORK:(Required)

Training Covered

Where

Date Trained

CAREER HISTORY – Start with the most recent employer, covering at least the last 5 years(Required)

Dates: From – To

Name, address, & phone No of employer

Position Held

MEMBER DECLARATION FORM

This is to let you know that now as a Member of REVOLUTION CARE you are no longer allowed to seek permanent work place with any of REVOLUTION CARE Clients. However if you are offered a permanent workplace and you accept the offer, it is your duty to let the Client know that they have to do it through REVOLUTION CARE as an INTRODUCTORY CHARGE has to be incurred.

The Client has to make a stipulated fee to REVOLUTION CARE. Failure to let the Client know, both YOU & the Client will be in breach of contract with REVOLUTION CARE. You will be legally sued and appropriate steps will be taken.

Signing below means you have understood the above statement.

Member of Staff’s Full Name(Required)

Date(Required)

I have read the above statement and fully understand what is required of me when placed to work out under REVOLUTION CARE. The above statement has also been read to me and also full explained.(Required)

Please state below (if any) place that you have already approached seeking for work prior to joining REVOLUTION CARE:

DATE

PLACE

NB: PLEASE DO LET REVOLUTION CARE KNOW OF ANY CHANGES THAT MIGHT OCCUR FOLLOWING SUBMISSION OF THE ABOVE INFORMATION TO AVOID ANY LIKELY INCONVIENCES THEREAFTER.