A kind, compassionate and effective domiciliary care


International Applicant Form

Inn Care Limited Equal Opportunities Policy covers all employees, or potential employees, and embraces the principle that all people shall be treated equally, regardless of their age, gender, ethnic origin, nationality, colour, religion, marital status, sexual orientation, religion or belief, disability, or offending background.

Data Protection Act 2018: By filling in this form, you give us the right, under the Data Protection Act 1998 to process the information you have given, including data of a sensitive nature, relating to your application for employment. Any processing of the data by us will be in accordance with our Policy and the processing principles set out in the Act.


    A. Personal Detail

    B. Next of Kin

    C. Education & Professional Training

    1. Secondary Education (secondary school)

    2. Higher Education (university / college / polytechnic)

    3. Further Education (Professional Training)

    4. Membership of Professional Bodies & Status of Membership

    D. Additional Questions

    E. Bank Details

    F. Employment History

    Employment 1: (present or most recent)

    Employment 2

    Employment 3

    Employment 4:

    Employment 5: (present or most recent)

    G. Job Flexibility

    H. References

    Reference 1: (present or most recent employer)

    Reference 2

    I. Rehabilitation of Offenders

    J. Declaration by Job Applicant

    • I have read and understood the information supplied to me in relation to this Job Position, and the information requested in
      this Job Application Form. I confirm that all information supplied by me is true and correct to the best of my beliefs.

    • I give consent for a third party, to view my employment file for compliance or inspection purposes

    • I authorise Amflo Care Services Ltd, to pay my wages, directly into my bank account, details of which I have given on this

    • I give the prospective employer the right to follow up all references, and to make any other job-related enquiries as may be
      deemed necessary.

    Equality and Diversity Monitoring Form

    A. Basic Details

    B. Ethnicity

    Please tick the box alongside the category that you feel best describes your ethnic origin, using the classification below


    Black or Black British

    Mixed Race

    Asian or Asian British

    C. Religion / Belief

    D. Disability

    The Equality Act 2010, provides for disabled people to have a legal right to fair treatment in employment matters. When answering this question please note that the Equality Act 2010 defines a disability as “a mental or physical impairment which has a substantial and long-term adverse effect upon a person’s ability to carry out normal day-to-day activities”.

    Confidential Medical Declaration

    GP / Doctor

    Health History

    Do you have, or have you ever suffered from, the following:

    Confidentiality and Data Protection

    CV and Other Important Documents

    Agreement and Declaration

    I agreed to abide by the following clauses:

    • I will maintain the confidentiality of all the service user records and any other information that involves their care / medical management of the patient.

    • I shall not disclose service user information in any manner that causes any harm to the service user or the relatives of the service user in any manner.

    • I shall keep all medical history records / information which include papers, images, and reports of the patient in a confidential manner.

    • I shall maintain confidentiality with regard to the verbal discussion and observation about the patient.

    • I shall withhold all personal information of the patient such as social security number, telephone number, mailing address, spouse details, key safe code etc.

    • I understand that unauthorized release of patient information to those who need not know it will make me liable for legal prosecution and disciplinary action by my employer as well.


    By putiing my name (signing) below, I acknowledge to have read and understood all the clauses specified above and signify my compliance to all the clauses specified herein above. In the event of violation of any of the clauses specified above the patient has the right to take appropriate action against me.

    Contact Us!

    Company registered in England and Wales with registration number 10684264. We would love to hear from you drop us a message on the form.

    England Head Office
    Phone: 0330 113 2948 or 07809357331
    Address: 342a Summer Lane, Birmingham B19 3QL

    Wales Head Office
    Phone: 0330 113 2948 or 07809357331
    Address: Office 5, 3rd Floor West Office, 113-116 Bute Street, Cardiff Bay, Cardiff CF10 5EQ

    Have a question?
    Write to us!