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Personal Details
Previous Addresses
Education & Skills

Please give details of education from age 11 and all qualifications gained, including those of a recreational nature.

Proof of qualifications will be required at interview. Please ensure these are available.

Work History

Current or last employment

Previous employment

Please provide details of your past employment, starting with the most recent. Account for any time not spent in employment or education, including periods of unemployment, voluntary work, or raising a family.


Include salary details only for employment in the last 5 years.  Please indicate if employment was part-time.

Further Information
Personal Statements

Motherwell Care will approach the referees of short-listed candidates only. Please give details of 3 people who can comment on your suitability for this post, one of whom must be your current or most recent employer. The other referees will ideally also be your most recent previous employers, where possible we will require references to cover the last five years’ work history, especially that of the current/last employer.


It is preferable that you seek professional references where possible and that these are from different organisations. Where you have worked in previous care roles confirmation will be sought regarding your employment and these will be verified.


If you cannot provide the details of your previous employers, you may substitute one or more of these with a referee who was a former tutor or teacher when you were in formal education.


If you cannot provide details of a teacher or tutor, we may accept a personal reference from a person of professional standing (e.g., a doctor, lawyer, accountant, recognised religious leader or teacher) who knows you, either professionally or personally.


You must not give the names of friends or relatives or colleagues that are/were not senior to you as referees. All references will be verified.

May references be taken up before interview?
May references be taken up before interview?
May references be taken up before interview?
Data Protection

Information from this application may be processed for purposes permitted under the General Data Protection Regulation. Individuals have, on written request, the right of access to personal data held about them.

Rehabilitation of Offenders Act

The post for which you are applying is in regulated activity as defined by the Safeguarding Vulnerable Groups Act 2006. As such, the role is exempt from the Rehabilitation of Offenders Act 1974 section 4(2) Exceptions Order 1975 as amended in 2013. You are therefore required to disclose information regarding any ‘unspent’ conviction, bind over, caution, or similar AND any which for other purposes are deemed ‘spent’ under the provisions of the Act but which would not be filtered by the Disclosure & Barring Service. Employers are not permitted to take filtered offences into account when making employment decisions. For more information about which cautions and convictions are filtered and should not be disclosed to us, visit:


A conviction, bind over, caution or similar will not automatically disqualify you from employment, but failure to disclose relevant information that would not be filtered may lead to your application being disqualified or, if you have already been appointed, you may be summarily dismissed.


If you are offered the post for which you are applying, Motherwell Care will first require a satisfactory enhanced Disclosure and Barring Service certificate and a check of the relevant DBS barred list(s) before permitting you access to children or vulnerable adults entrusted to the care of our Organisation. For care posts, you will also be required to confirm that you are not disqualified from that role by the Disqualification from Caring for Children (England) Regulations 2002.

Application Declaration

I confirm that all information provided in the application is complete and correct and understand that any false or misleading information will result in my application being disregarded, or if Motherwell Care Ltd’s employment, could result in my immediate dismissal. And if this application is as a self-employed, then it could result in immediate termination of services.


I agree that if offered provisional employment or provision of services; I consent to Motherwell Care Ltd to undergoing vetting checks, which include but are not limited to; Disclosure and Barring Checks, references and ID checks.


I agree that if offered provisional employment or or provision of services and if I have declared that I will require reasonable adjustment to perform my duties, I understand that Motherwell may be asked my permission for a medical report to be released to MOTHERWELL Care Ltd by my GP, or referred to an independent medical advisor. No medical report will be requested without prior consent.


With the exception of those listed below, I do not have any family or close relationships to existing employees of Motherwell Care Ltd, including Director. If I become aware of relationships at a later date I will declare these to Human Resources.

Please read the statements above carefully, and only sign below if you can agree with all the statements above.

Your application has been submitted

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