Christies Carer Online Application Form: Page 1

Care Assistant Application Form	Page 1 of 8
Please complete all questions as far as possible. All the questions are important so if you leave any questions blank it could affect your application. Some questions are essential and we cannot proceed if you do not answer them. These questions are in red.

PLEASE GIVE US YOUR PERSONAL DETAILS.
1: Surname:	4: Title	(Mr/Mrs etc):
2: Forenames in full:	5a: Daytime Phone:
3: Present Address:	5b: Evening Phone:
	5c: Mobile Phone:
	6: Fax:
	7: Email:
8: Date of Birth: / / 9: Your Age:
10: Mother's Maiden Surname
Important Note: Your Mother's maiden name (her surname before her marriage) is used throughout as a password - you will need to quote it exactly as you enter it here in order to access your details at a later date. Make sure you keep a careful note of the name you enter. The system is case sensitive so "SMITH" is treated as being different from "smith" or "Smith".
Nationality
11: Do you have a British or EU Passport?	Yes No
12: Are you a citizen of one of these countries?
13: Was your father born in the UK?	Yes No
14: Was your mother born in the UK?	Yes No
15: Were any of your Grandparents born in the UK?	Yes No
16: Are you married to someone who holds a UK passport or an Ancestry Visa?	Yes No
17: What is your Nationality?
18: Are you a student at a UK college/university?	Yes No
19: What kind of Visa will you have to enter the UK?
20: Is English your First or Second Language?	First Second
21: Do you smoke?
Driving in UK etc
22: Do you drive?	Yes No
23: What driving licence do you hold?
24: What type of licence?	Manual Automatic
25: Are you willing to drive in the UK?	Yes No