Total Community Care - Specialists in spinal & neurological care

Providing bespoke care nationwide for clients with spinal injuries and neurological conditions

Job Application

    About You
    Your Experience

    Qualifications Relating To Care

    Title of Qualification

    Level Achieved

    Date Completed

    Qualification 1

    Qualification 2

    Qualification 3

    Qualification 4

    Qualification 5

    Qualification 6

    Qualification 7

    Qualification 8

    Previous Employment Details

    You must ensure you cover the last five jobs

    Dates From - To


    Job Title

    Reasons For Leaving

    Max 20 characters

    Employer 1


    Employer 2


    Employer 3


    Employer 4


    Employer 5

    Background Checks


    Please supply the name and address of two referees (one must be your current/last employer)

    References will not be applied for until we have offered you a position, and it has been accepted.

    Reference 1

    Reference 2


    Please select at least one of the shifts you are able to do in each category:

    Practical Experience

    Care Tasks

    Please tick all the care tasks you have experienced.


    Please tick any disabilities you have experienced/worked with.

    General Questions

    Please answer the following questions:


    Your Declarations

    Total Community Care Limited is an Equal Opportunity Employer and no individual will be unfairly disadvantaged on the grounds of race, gender, disability, age, HIV status, sexual orientation, social
    class or religion.

    You are required to disclose your criminal background, if any. Failure to disclose any previous convictions, which are later identified on a Disclosure and Barring Service (DBS) check, could result in any offer of employment being withdrawn.

    Please give details of any criminal convictions, cautions or bind over orders. The post applied for is exempt from the provisions of the Rehabilitation of Offenders Act 1974 (Exceptions) (Amendment) Order 1986.

    Conviction 1

    Conviction 2

    Conviction 3

    Conviction 4

    N.B. All Successful applicants will be required to undertake Disclosure and Barring Service Enhanced Check and a P.O.V.A (Protection of Vulnerable Adults) Check. Please indicate by placing a tick in the box provided that you agree for this check to be carried out.

    Please Note: We do not discriminate against any previous caution or conviction.

    This application form will be photocopied and sent to our client/s for their perusal. Personal information e.g. address and telephone number etc will be deleted before being sent. Please indicate by placing a tick in the box provided that you agree for your information to be passed to our client/s.

    I affirm that all the information given in this application form is truthful and accurate to the best of my knowledge

    Failure to complete all sections of this application form may result in your application not being considered.

    TCC Ltd aim to ensure that discrimination does not take place. In order to help us monitor the effectiveness of this activity (and for no other reason), you are asked to provide the information requested below.

    Ethnic/Cultural Origin

    Please tick one of the following:


    BritishIrishAny other white background


    White & Black CaribbeanWhite & Black AfricanWhite & Asian

    Asian or Asian British


    Other Ethnic Groups

    ChineseAny other Ethnic Group

    Not Stated

    Not Stated

    General Data Protection Regulation

    Total Community Care (TCC) have a legitimate interest in holding personal data in accordance with GDPR, this is to enable TCC to undertake its business activity of the provision of health and social care support for individuals living in their own home.

    I hereby freely give my prospective employer, TCC, consent to use and process my personal data relating to my job application, including

    • Previous employers
    • Contact details
    • Skills and qualifications obtained
    • Work and personal references
    • Ethnic monitoring data
    • Criminal convictions

    In giving my consent:

    • I understand that if I am successful with my application, further personal data will be required from me to process my offer of employment and my ongoing employment with TCC. Once I have been employed by TCC, I understand that my data would be held for a two year period only after leaving, unless required for longer in relation to Health and Safety legal requirements for the sector
    • I understand that if I am unsuccessful with my application my data will be automatically destroyed after one year.
    • I understand that I can ask to see this data to check its accuracy at any time via a subject access request (SAR).
    • I understand that I can request that data that is no longer actively required, can be removed from my file and destroyed.
    • I understand that I can ask for a copy of my personal data held about me at any time, and this request is free of charge.
    • I understand further information regarding data protection and GDPR can be provided by contacting the Data Controller, Reg Perrins or Data Protection Officer, Michelle Radford.

    I consent - Date of acceptance: