Carer Starter Form

1

Personal details

Title

First name(s)

Middle name(s)

Surname

Date of birth

Contact number

Email address

National Insurance number

Year of marriage (if applicable)

Previous names (including maiden name)

Dates previous names were used

Evidence of name change supplied

Yes N/A

Please provide evidence of name changes where required, such as a marriage certificate, deed poll or divorce documentation. You can upload it in section 12.

2

Current address and five-year address history

Address line 1

Address line 2

Town/city

County

Postcode

Date moved in

Previous addresses (last five years, no gaps)

If you have lived at your current address for five years or more, you can leave this blank.

3

Right to work in the UK

Which applies to you? I have the legal right to work in the UK. I require a visa or immigration permission to work in the UK.

Right-to-work share code (if applicable)

Expiry date of permission (if applicable)

Generate a share code at gov.uk/prove-right-to-work. Pure Hearts Support Services Ltd will complete the required checks before employment begins. Alternative prescribed evidence may be used where permitted.

4

Role, experience and availability

Driving and vehicle requirements will be discussed in relation to the duties of the role.

5

Next of kin / emergency contacts

Contact 1

Full name

Relationship to you

Contact number

Alternative number

Contact 2

Full name

Relationship to you

Contact number

Alternative number

Please make sure your contacts know they have been listed and that their details may be used in an emergency.

6

Bank details for payroll

Account holder's name

Bank / building society

Account number

Sort code

Used for payroll only and handled securely. You can leave this blank and give your details to the office at your start if you prefer. Bank details are never kept in your browser.

7

Tax and student loan declarations

This helps payroll apply the correct tax code. We may also ask you to complete the current HMRC starter checklist.

Choose the statement that applies to you Statement A – This is my first job since 6 April this tax year, and I have not received taxable Jobseeker's Allowance, Employment and Support Allowance, taxable Incapacity Benefit or a State/occupational pension. Statement B – Since 6 April this tax year I have had another job, but this is now my only job. I have not received a State/occupational pension. Statement C – I have another job or receive a State/occupational pension. None of these applies – I'll speak to the payroll administrator.

Student or postgraduate loan that may need payroll deductions?

Yes No Unsure

Plan, if known

8

Full employment history

Include care and non-care roles, agency work, self-employment and periods not employed, starting with the most recent. A CV helps, but it doesn't replace the full history.

Gaps in employment

Explain all gaps, for example education, caring responsibilities, unemployment, travel or other personal circumstances.

I have never been employed.

9

References

CQC safer recruitment. If you have worked in care, please give at least one reference from a health or social care setting, normally your most recent care employer. Employment references should use an official business email where possible. A character referee must have known you for at least 3 years and must not be a family member, partner or relative (this is a Pure Hearts policy, not a specific CQC rule).

Which best describes you? A – Never worked before. B – Previously employed but never worked in health or social care. C – Most recent employer was in health or social care. D – Previous care experience, but most recent employer was not a care provider. E – Care experience was not with either of my two most recent employers.

I consent to Pure Hearts Support Services Ltd contacting the referees listed for recruitment and employment verification.

10

DBS and safer recruitment

Do you currently hold a DBS certificate?

Yes No

Registered with the DBS Update Service?

Yes No N/A

DBS certificate type (if applicable)

Date of issue (if applicable)

Willing to complete the appropriate DBS check?

Yes No

Pure Hearts Support Services Ltd will decide the appropriate level of DBS check based on the role and legal eligibility. A previous certificate may not replace the checks required for this employment.

I have read, or have been directed to, the DBS applicant privacy information and understand how my data will be processed.

11

Training and qualifications

Fill in any you have. Leave the rest blank.

Qualification / training	Awarding body / provider	Date completed	Expiry / renewal

Willing to complete the mandatory training required for your role?

Yes No

12

Supporting documents

Upload what you have now. Anything missing can be brought to your interview. PDF, Word, JPG, PNG or HEIC, up to 10 MB each.

Identity & right to workPassport, driving licence, share code result

Proof of address & name changeUtility bill, bank statement, marriage certificate

CVIf you have one

Qualifications & trainingCertificates (please don't upload your DBS certificate – bring it to interview)

13

Declaration of accuracy

I confirm that the information provided in this form is, to the best of my knowledge, complete and accurate. I understand that Pure Hearts Support Services Ltd may verify the information provided, contact previous employers and referees, and complete appropriate recruitment, identity, right-to-work and DBS checks. Any offer of employment may be subject to satisfactory checks, references, qualifications and training requirements relevant to the role. I agree to notify Pure Hearts Support Services Ltd if any material information changes.

Type your full name as your signature

Date

I agree to the declaration above, and I understand that typing my name counts as my signature. I have read the privacy notice and understand how Pure Hearts will use my information for recruitment.

Sent securely to the Pure Hearts recruitment team.

Thank you, your application has been sent

Personal details

Current address and five-year address history

Previous addresses (last five years, no gaps)

Right to work in the UK

Role, experience and availability

Next of kin / emergency contacts

Contact 1

Contact 2

Bank details for payroll

Tax and student loan declarations

Full employment history

Gaps in employment

References

DBS and safer recruitment

Training and qualifications

Supporting documents

Declaration of accuracy

Upload your completed form

Your details