Working with Us

Note Document Required for Employment

Two forms of proof of address dated within the last 3 Months
Acceptable Proof:
• HMRC Letter
• Bank Statement
• Utility Bill
• National Insurance Letter
• Local authority letter
• Others – check with us

Proof Of National Insurance
Acceptable Proof:
• NI Card
• NI Letter
• P45/P60
• Tax Code Notification Letter
• Universal Credit Letter
• DWP Letter

Right To Work (RTW) in the UK
Acceptable Proof:
• British Passport
• EU Passport / EU ID Card with proof of settlement
• NON UK & EU Passports should be accompanied with a BRP Card

Photographic ID
Acceptable Proof:
• Passport
• Driving Licence
• ID Card
• BRP

Criminal Check
Acceptable Proof:
Updated Enhanced DBS or DBS registered with update service covering both children and adults

Our Recruitment Process

1 - Complete Application Form

(Below)

2 - Complete Pre-Employment Health Questionnaire Form (Click to Complete)

(Click to here to Complete Form)

3 - Complete New Employee Form

(Click to here to Complete Form)

4 - Complete Non-Disclosure Form

(Click to here to Complete Form)

5 - We will review summited forms & contact you accordingly

Chommzy Care Services Limited – Candidates Application Form

"*" indicates required fields

Step 1 of 5

The information you supply on this form will be treated in confidence.
SECTION 1 : Personal Details
Post Applied For:*

Title:*
Mr, Mrs, Miss, Ms, Other

Name*
First Last
Have you ever been known by any other names:*
Yes
No
If Yes, enter names

Email*

Home Telephone Number:
Mobile Telephone Number:*
Sex:*
MaleFemalePrefer not to say
Date of Birth:*

Day
Month
Year

Are you aged 18 years or over:*

Yes

No
National Insurance Number (NI):*

Are you eligible to work in the UK?*

Yes

No
Nationality:*
AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country

Right To Work (RTW) in the UK – Acceptable proof:*
British Passport
EU Passport / EU ID Card with proof of settlement
NON-UK & EU Passports should be accompanied/ Share code
Upload proof of Right to Work in the UK*
Max. file size: 10 MB.
– British Passport – EU Passport / EU ID Card with proof of settlement
Enter your digital share code*

Disclosure and Barring Service (DBS) Certified:*

Yes

No
Type of Disclosure?*
Standard
Enhanced
DBS Date of Issue:*
MM slash DD slash YYYY

Enter DBS Reference Number:*

Are you on the Update Service?*

Yes

No
Do you have a current full driving license:*

Yes

No
Do you have your own transport:*

Yes

No
Address*
Street Address City County / State / Region ZIP / Postal Code Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands

Proof of Address:
Please upload 2 (two) items stating your full name and current home address- Accepted Documents – A utility bill (gas, electric, satellite television, – Landline phone bill) issued within the last three months – Local authority council tax bill for the current council tax year – Bank, Building Society statement (last three months) – Original mortgage statement from a recognised lender issued for the last full year – HMRC correspondence within the current financial year (e.g. P45 / P60, self-assessment letter, tax demand, etc.)
Proof of Address 1*
Max. file size: 5 MB.
Proof of Address 2*
Max. file size: 5 MB.

SECTION 2 : Rehabilitation of Offenders Act
Have you ever been convicted of a criminal offence?*

Yes

No
Have you any prosecutions pending?*

Yes

No
Details of Offence(s) and Sentence
(This information will be disclosed by the Criminal Records Bureau check which will be required if successful. Please note a criminal record will not necessarily be a bar to employment)
SECTION 3: Health
Number of days absent in the last 2 years:
Are you registered disabled?*

Yes

No
If yes please provide your disability number and details:
SECTION 4: Education
Education and Training*
Please list your qualifications in reverse order, starting with the most recent first. Also, include any training that you have received which did not lead to a qualification but which you feel is relevant to the post. If short-listed for an interview, please be prepared to bring original copies of any certificates relating to post-school qualifications or vocational qualifications.
Date Obtained:
Place of study & address:
Examinations taken & grades:

Other Qualifications:*
Please give details of any other qualifications obtained or relevant courses attended.
Date Obtained:
Place of study & address:
Examinations taken & grades:

SECTION 5: Employment Record
Please list chronologically, starting with current or last employer*
Name of Employer:
Employer Address:
Length of Employment:
Salary:

Date From:*
DD slash MM slash YYYY

Date To:*
DD slash MM slash YYYY

Main Duties and responsibilities:
If currently employed how much notice are you required to give?

(weeks)
Reason for leaving or seeking new employment:*
5: List of Employer (Employment History): Note: Please click on the + sign to add more employment history.
Please give summary details of all your previous employment (most recent first for a minimum of 10 years if Applicable). Please ensure you include all part-time and temporary positions held, even those that are not relevant to your application. Please ensure you include any periods of unemployment or any other time that is not accounted for.
Name of Employer:
Employer Address:
Length of Employment:
Reason for leaving:

SECTION 6: Reference
(1) Referee:*
Please give the names and addresses of your two most recent employers (if applicable). If you are unable to do this, please clearly outline who your referees are.
Name of Referee:
Referee Job Title:
Email:
Telephone No:
Company Name:
Address:
May we contact your references prior to job offer:*
Referee 1:

Yes

No
(2) Referee*
The second referee can be your present employer or character reference (We will accept personal friends – No relatives.)
Name of Referee:
Referee Job Title:
Work Relationship:
Email:
Telephone No:
Organisation:
Address:
May we contact your reference prior to job offer:*
Referee 2:

Yes

No
SECTION 7: Emergency Contacts
Emergency Contacts/ Next of Kin:*
First Name :
Last Name:
Telephone Number:
Email:
Address:

SECTION 8: Personal Attributes
Please give details:
SECTION 9: Declaration
I confirm that the information provided in this application (and within my Curriculum Vitae if applicable) is both truthful and accurate. I have omitted no facts that could affect my employment. I understand that any false misleading statements could place any subsequent employment in jeopardy. I understand that any employment entered into is subject to documentary evidence of my right to work in the UK and satisfactory references. I expressly consent to personal data contained within this form being recorded for the purposes of assessing suitability for the post and may form the basis of any subsequent personnel file.
Signed:*

Enter Fullname as signature proof.
Date:*
MM slash DD slash YYYY

Chommzy Care Services Limited undertakes that it will treat any personal information that you provide to us, or that we obtain from you, in accordance with the requirements of the Data Protection Act 1998. After initial assessment, Chommzy Care Services Limited may keep your details on file for opportunities that may arise in the future. Please tick if you do not wish us to hold your details.*
Yes
No
Upload CV:
Accepted file types: pdf, doc, docx, jpg, Max. file size: 5 MB.
Filetypes: pdf, doc, docx, jpg

SECTION 10: Recruitment Monitoring Form
This sheet will be separated from your application form upon receipt and does not form part of the selection process. It will be retained by Human Resources purely for monitoring purposes.
Application for the post of:
To help us ensure that our Equal Opportunities Policy is fully and fairly implemented please COMPLETE THIS SECTION OF THE APPLICATION FORM.
What is your Ethnic Group?
Choose ONE section from A to E, and then tick the appropriate box to indicate your cultural background.
A: White

White UK

Irish

White -non-UK

Any other white background
(please give details):
B: Black or Black British

Black Caribbean

Black African

Any other Black background
(please give details):
C: Mixed

White & Black Caribbean

White & Black African

White & Asian

Any other Mixed background
(please give details):
D: Chinese or other ethnic group

Chinese

Vietnamese

Any other ethnic background
(please give details):
E: Asian or Asian British

Indian

Pakistani

Bangladeshi

Any other Asian background
(please give details):
F: I do not wish to provide this information

Section Break
Gender:
Male
Female
Are you registered disabled?*

Yes

No
If yes please provide your disability number and details:
Age Group:*
16- 25
26 – 35
36 – 45
46 – 55
56 – 65
66 – 70
over 70
Media:

Please sate where you saw this advised.
Asylum and Immigration Act 1996:
It is now a requirement that before any offer of employment can be made, all candidates are to provide confirmation of their eligibility to work in the UK. Please bring one of the following original documents with you if invited to interview: a passport or an immigration and nationality directorate application registration card which evidence the right to work in the UK or a UK residence permit issued to an EEA national which confirms right of entry to or residence in the UK.
CAPTCHA
Phone
This field is for validation purposes and should be left unchanged.

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