Application Form

Which job are you applying for?

Personal Details:

     

Title

 

Forenames

Surname

Address

 

Post Code

 

Tel.

 

Email.

 

National Insurance No.

 

Do you hold a current British Driving Licence

Yes

No

 

Do you have daily use of a car?

Yes

No

 

     

About where you live:

 

 

Do you live in a

House

Bungalow

Maisonette

 

Flat

 

 

       

Is it

Owned

Privately Rented

Council Rented

       

Do you have sole use of your garden?

Yes

No

 

Is your garden completely secure on all sides?

Yes

No

       

About you:

 

   

Other than holidays are there any other times of the year you will be unable to care for a dog?

Yes

No

 

 

If yes, give details

 

 

Do you have any regular daily commitments that may take you away from your house for longer than 2 hours?

Yes

No

 

 

If yes, give details

 

 

What is the maximum number of dogs you could accommodate in your house - 1,2 or 3?

Dogs

   

As a VIPs carer you may be asked to care for puppies, elderly or special needs dogs. You may be asked to wash/bath/groom a dog, to exercise it 3 times a day, and to administer oral medication. Would you object to providing any of these services?

Yes

No

 

 

If yes, give details

 

 

     

About your family:

   

Do you live with other people?

Yes

No

 

Name

Relationship

Age

1

2

3

4

Do you have any other pets?

   

Yes

No

 

 

If yes, give details

 

 

     

About your experiences:

   

Have you ever owned your own dog?

   

Yes

No

 

 

If yes, give details

 

 

Have you ever worked with dogs?

   

Yes

No

 

 

If yes, give details

 

 

Have you ever been banned from keeping animals?

 

Yes

No

 

 

If yes, give details

 

 

Under the terms of Animals Establishments Act 1963, carers must supply details of a relative, friend or neighbour who will act as a "key holder" for their property in the event of fire or emergency. Please provide details of that person below:

       

Secondary Education:

     

Examinations Taken

Level

Grade

High and Professional Qualifications

 

Examinations Taken

Level

Grade

       

Present or Last Job:

     

Name and Address of present or most recent employer

Job Title

 

Employment Dates

From

To

 

Current or last earnings (gross)

   

Notice required by your present employer

months

 

 

Reason for leaving

 

Supporting Information:

Please give a description of your present or most recent employment along with any other relevant information in support of your application. Include any details of your interests if these are relevant to this application.

       

References:

     

Name

 

Relationship

 

Tel. No.

 

May we take up references prior to the interview?

Yes

No

 

Name

 

Relationship

 

Tel. No.

 

May we take up references prior to the interview?

Yes

No