Live-in Carer Application Form

Looking for satisfying work and being able to work with a diverse range of clients? Apply today.

Carer Application Form

Personal details

Passport and work permit details

Data Barring Service (DBS)

General Information

Preferences regarding work

Please specify which types of work you would prefer. You should tick all appropriate boxes.


Please give the names, occupation and contact addresses / details of 3 people we can contact for references. One of which must be your current or most recent employer. If you have not been employed please provide the name of a professional person who can comment on your suitability for this position.

Reference 1


Reference 2


Reference 3


Professional Experience

Personal Hygiene

Bath / shower / strip washCare of hairCare of feetDressing / undressing
Bed bathCare of eyesCare of fingernailsMouth careUse of bath aids


Applying a conveenAttaching a night bagBedpans / commodesChanging a catheter bag
Continence careEmptying a catheter bagStoma careOther (please specify below)

Care Duties

Assisting with medicationPressure area carePhysical restraint skills
Simple dressing proceduresPalliative careOther (please specify below)


FeedingPreparing meals
Food handlingOther (please specify below)


Moving and handling clientsUse of hoists
Use of walking aidsOther (please specify below)

Practical Tasks

BedmakingCollecting benefitsLight housework

Recording temperatureShoppingOther (please specify below)

Administrative Abilities

ConfidentiallityObserving/recording changesSign language
Report writingArranging appointmentsRecording instructions from GP

Training Received

Manual handling (adult)

Infection control

Fire safety

First aid

Essential food hygiene

Observational skills

Lone worker

Management of aggressive or violent behaviour

Abuse awareness (POVA)

Abuse awareness (POCA)

Safeguarding Training (Adult)

Health & safety (incl COSHH and RIDDOR)

Basic life support (Adult)


Other certification

Do you consent to the use and processing by Cheriton Homecare of personal data for the purpose of farthing your application for a position as a self employed care assistant with the company?


Do you agree to our privacy policy, so that we can contact you about your application?



The information that I have given in this application form is, to the best of my knowledge, complete and accurate in all respects, and I am not aware of any reason why I am not fit for this work. I understand that knowingly giving false information will disqualify me from registration with the agency.