Interview Start
Time of commencement of interview :
Personal Details



First Name & Middle Name

Date of Birth:
Contact Details



Home Phone Number:

Mobile Phone Number:


Job Applied For
Role being interviewed for:


'Driver' or 'Walker'?

Full Driving Licence?

Use of a vehicle for work?


General appearance and hygiene of acceptable level?

Hair neat and groomed ?

Clean shaven or facial hair (if any) of neat appearance ?

Clothing worn of suitable standard for interview ?

Were any tattoos visible at time of the interview unacceptable?

Will it be covered when in uniform?

Was any body jewellery worn at the time of interview unacceptable?

Will it be covered when in uniform?

Overall score for appearance and presentation at interview (10 highest)

General Comments

Background Knowledge

Do they currently work for the company?

What is their current job role?

Do they know anyone that works for the company


What do you know about the company & the services we provide? (Rate Knowledge)

What knowledge do they have about the role they have applied for? (Rate their knowledge)

Where did they hear about the vacancy?

Basic skills

Handwriting? (Check Application Form)

Spoken English?

Do they have a maths qualification?

Do they have an English qualification?

Do they have any learning disabilities? i.e dyslexia


Rate their relevant basic skills (10 highest)

General Comments


Do they hold any certificates relevant to the position they are applying for?


Rate their Qualifications and Training in relation to the role applied for (10 highest)

General Comments

Work History and Experience

Have they worked in the care industry previously?

Details: (Company and Responsibities)

Are they currently employed ?

Notice Period?

Have they previously worked as a Lone Worker?

Will they be required to undertake Supervisions or Management tasks?

Do they have any supervision or management training ?


General Comments

Further Training

What areas do they believe they could do with further training or experience in to make them a better potential employee?

Rate their suitability based on their answers above (10 highest)

General Comments

What are they looking for ?

What are their goals for the next 6 to 12 months ?

What are their goals for the next 2 to 5 years ?

Rate their suitability based on their answers above (10 highest)

General Comments


What qualities do they believe a good worker in the role applied for must have?

Why do they feel that they have these qualities?

What is the greatest achievement in their personal life to date?

Describe a difficult decision you had to make in your work life and how you made it?

What is the greatest achievement in their work life to date?

If you they were to be offered a position - what would they be most apprehensive about?

Rate their suitability based on their answers above (10 highest)

General Comments

What was their personality during interview?

General Comments

Applicant Questions

Do you have any questions regarding this interview, the role or the company in general ?

General Comments

Final Question

Why do you feel we should employ you? What makes you the person we want to employ in preference to the next applicant ?

Rate their answer above (10 highest)

General Comments

Recommendation and Job Offer

Overall, are they suitable for the position ?


Authorisation required to offer job?

Authorising Person:

Was the job offer made at the interview?

Reason for not making offer:

Was the offer Accepted?

Photocopy Certificates if applicable

DBS Check information

Reference Details

Photocopy of Driving Licence

Photocopy of Valid Insurance Certificate

Photo for ID Card

Details why offer not accepted:

Interview Conclusion
Time of conclusion of interview :

Any Further Information required?

Pass all details to HR for processing

Interviewer Signature:
Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.