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Mayfield Residential Care Home, Crewe, Cheshire

Mayfield Residential Care Home - Employment Application Form

Mayfield House - Mayfield Mews - Crewe - Cheshire - CW1 3FZ - Telephone 01270 500414

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Application for Employment at Mayfield Residential Care Home

Position Applied For

Full Name

Home Address

Telephone Number

Mobile Number

Email Address

Driving Licence Held

Details Of Endorsements

Education History

Employment History

Other Employment

(please note any other employment you would continue if you were successful in obtaining this position)

Diseases Disorders Allergies

(please list any diseases, disorders, allergies, muscular or skeleton injuries from which you have suffer)

Disability Details

(please give details & specify any special needs in relation to your disability)

Are You Disabled?

Criminal Record Details

(please note any criminal convictions, except those “spent” under the Rehabilitation of Offenders Act 1974)

Do you have a Criminal Record

Leisure

(please note here your leisure interests, sports & hobbies, other pastimes etc)

Absences From Work

(please list all absences from work in the past 12 months, and the reasons for these)

Medicines Drugs Treatments

(please detail any form of medicine, drugs or treatment you are currently and/or regularly receiving)

DECLARATION (Please read carefully before submitting this application)

I confirm that the above information is complete and correct and that any untrue or misleading information will give the Directors of Mayfield Residential Care Home the right to terminate any employment offered.

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Mayfield Residential Care Home - Care Manager