Application Form Step 1 of 4 25% Please note: Applicants must have a minimum of 3 months of UK care experience, supported by references. We are recruiting nationwide in the UK; however, sponsorship is not available at this time. Kindly complete this form in full and upload all required supporting documentation as requested.Post Applying for:*Select Job RoleHealth Care AssistantRGNRMNRLDNODPsSocial WorkerDomestic WorkerDrOtherPersonal Details 1Name* Title Mr.Mrs.MissMs.Dr.Prof.Rev. First Name Middle Name Last Name Location*Mobile No*Email* Date of birth* DD slash MM slash YYYY National Insurance No:* NI Document*NI letter for students, BRP Back for others. This document should be clear, sharp (readable), without background and foreground images, vertically straight. Accepted file types: jpg, gif, png, jpeg, pdf, Max. file size: 1 MB.NMC Pin No: RCN Number: HPC Number: BandPlease selectBand 1Band 2Band 3Band 4Band 5Band 6Band 7Band 8ABand 8BBand 8CBand 8DBand 9AddressYour Current Address* Street Address City County / State / Region ZIP / Postal Code Personal Details 2NationalityPlease selectBritishEU CitizenOtherGenderPlease selectFemaleMaleOtherPrefer not to sayReligionPlease selectBhudistChristianJewishHinduMuslimSikhOtherNoneRace/EthnicityPlease selectWhite BritishWhite (other)White IrishMixed raceIndianPakistaniBangladeshiOther Asian (non-Chinese)Black CaribbeanBlack AfricanBlack (others)ChineseOtherSexual OrientationPlease selectStraight/HeterosexualBisexualGay ManGay Woman/LesbianPrefer not to answerOtherEmployment EligibilityAre you permitted to work in the UK?* Yes No What proof of Right of Work in the UK do you hold?:* British Birth Certificate British Passport Settled Status/Leave to Remain Visa / Work Permit Biometric Resident Permit (BRP) Others Resident Permit No: Resident Permit Expiry Date:If it has no expiry please put a day 10 years from today. DD slash MM slash YYYY Passport No: Passport Expiry Date:If it has no expiry please put a day 10 years from today. DD slash MM slash YYYY Upload a copy of your Resident Permit or BRP (front and back)This document should be clear, sharp (readable), without background and foreground images, vertically straight. Drop files here or Select files Accepted file types: jpg, gif, png, jpeg, pdf, Max. file size: 128 MB, Max. files: 10. Upload a copy of your passport data page*This document should be clear, sharp (readable), without background and foreground images, vertically straight. Drop files here or Select files Accepted file types: jpg, gif, png, jpeg, pdf, Max. file size: 128 MB, Max. files: 10. Upload a copy of UK entry stamp pageThis document should be clear, sharp (readable), without background and foreground images, vertically straight. Drop files here or Select files Accepted file types: jpg, gif, png, jpeg, pdf, Max. file size: 128 MB, Max. files: 10. Upload a copy of UK DBSThis document should be clear, sharp (readable), without background and foreground images, vertically straight. Drop files here or Select files Accepted file types: jpg, gif, png, jpeg, pdf, Max. file size: 128 MB, Max. files: 10. Driving DetailsDo you have full Driving Licence that allows you to drive in the UK? Yes No Driving Licence No: Upload a copy of Drivers LicenceThis document should be clear, sharp (readable), without background and foreground images, vertically straight. Drop files here or Select files Accepted file types: jpg, gif, png, jpeg, pdf, Max. file size: 128 MB, Max. files: 10. Do you have access to a car that you can use for work? Yes No Have you been banned from driving or do you have any current endorsements on you licence? Yes No Are all your vehicle documents up to date and valid? Yes No How would you travel to work if assigned?DriveBusBicycleTrainTramOtherPlease note: you have to provide copies of all IELTS certificates held by you.Next of kin detailsFull Name* Prefix Mr.Mrs.MissMs.Dr.Prof.Rev. First Last Relationship to you:* Home/Work PhoneMobile No*Email Address* Street Address City County / State / Region ZIP / Postal Code Your Work PreferenceWhen are you able to work?* Part Time Full Time EDUCATION & EMPLOYMENT HISTORYPlease ensure you complete this section even if you have a CV. The NHS states that “Employment history should be recorded on an Application Form which is signed” Please ensure that you leave no gaps unaccounted for and it covers full work history including your education. Please use extra paper if required. Full work history including your education Dates to and from are shown in a mm/yy format Dates are continual with NO gaps Where there have been gaps in work history please state the reason for the gaps Lists all relevant training undertakenEmployment History*Please print clearly details of the past five years work history (Most recent first) Use the + sign to add more roles as required. There shall be no gaps in employment history.EmployerPositionDutiesDate (From - To)Reason on leaving EducationPlease print clearly details of education history (starting from primary to most recent). Use the + sign to add more roles as required. Education*InstitutionCourseDates (from - to)Grade Upload CV*There shall be no gaps on the employment history on the CV. Accepted file types: jpg, gif, png, pdf, jpeg, docx, Max. file size: 128 MB.Upload School Certificates*This document should be clear, sharp (readable), without background and foreground images, vertically straight. Drop files here or Select files Accepted file types: jpg, gif, png, jpeg, pdf, Max. file size: 128 MB, Max. files: 10. SKILLS, EXPERIENCE & TRAININGHave you completed mandatory training within the last year?* Yes No Mandatory TrainingPlease tick if you have completed the following training within the last 12 months*Please enclose copies of your training certificates Moving & Handling Basic life support Health and Safety Fire Safety First Aid Infection Control Food Safety & Nutrition Medication Administration Safeguarding Vulnerable Adults & Children Training Titles and Dates:Please add training titles and dates.Have you completed other health care training?* Yes No Other Training/Courses & QualificationsPlease check which training you have completed and the date on the notes (certificates must be provided). Diploma in Health & Social Care L3 Diploma in Health & Social Care L2 Personal Safety (Mental Health & Learning Disability) Intermediate Life Support Advanced Life Support Complaints Handling Handling Violence and Aggression DOLLS & Mental Capacity COSHH Data Protection Equality & Inclusion Lone Worker Training Resuscitation of the Newborn (Midwifery) Interpretation of Cardiotocograph Traces (Midwifery) MAPA PMVA Training Titles and DatesPlease list training titles and dates.APRAISALSIn order to work in the NHS you will need to be appraised annually by a Senior Practitioner of the same discipline, this person will become your “appraiser” Please give details below of the Senior Practitioner who you have made arrangements with to act as your appraiser.Please give the date of your last appraisal DD slash MM slash YYYY Name of Appraiser First Last Position and Grade of Appraiser: Branch Address: Street Address City County / State / Region ZIP / Postal Code PhoneEmail Enter Email Confirm Email YOUR DBS STATUS & UNIFORMDo you have a current DBS (Disclosure Barring Service) (formally known as CRB)?*Current DBS Disclosure (formally known as CRB) Yes No Is your DBS on update service?* Yes No Date of issue:* DD slash MM slash YYYY Disclosure number All applicants who cannot provide a registered DBS or full immunisation record will be required to complete at their own cost. The company will cover the cost of any Mandatory Training updates however cancellations outside of 48 hours and late attendances will be charged to the candidate.UniformCandidates will be required to purchase uniform if required at the cost of £20 this will be deducted from your timesheet once you have started working through us. Please fill in the box below stating your uniform size and quantity.Your Tunic Size*Female681012141618OtherIf other, please enter value:*Your Tunic Size*MaleSMLXLXXLOtherIf other, please enter value:* DECLARATIONSHealth DeclarationDo you or have you ever suffered from long term illness?:* Yes No Have you ever required sick leave for a back or neck injury?:* Yes No Do you suffer from any back or neck injuries?:* Yes No Have you been in contact with anyone who is suffering from a contagious illness within the last six weeks?:* Yes No Do you suffer with a communicable disease?:* Yes No Are you currently receiving active medical attention?:* Yes No If you have answered ‘yes’ to any of the above, please give details:Are you registered disabled?:* Yes No How many days have you been absent from work due to illness in the last 12 months?:State reason(s) for absence:Disclosure Barring Service (DBS)The Disclosure and Barring Service (DBS – formerly Criminal Records Bureau CRB) is the executive agency of the Home Office responsible for conducting checks on criminal records. We are registered body for receipt of DBS disclosure information. NHS Trust and Private Sector hospitals and nursing homes insist on agencies making information recruitment decisions which require DBS checks to be made on all staff. It is a condition of proceeding with your application that you apply for a DBS disclosure check. The disclosure will be compared with the information given below and any inconsistencies could invalidate your application or lead to the cancellation of your registration with us.Have you been convicted of a criminal offence?* Yes No Have you ever been cautioned or issued with a formal warning for a criminal offence?* Yes No If you have answered ‘yes’ to either of the above questions please list details including dates below* I confirm the above is true and I understand that a DBS check will be sort in the event of a successful application. Rehabilitation of Offenders Act 1974 and Criminal RecordsBy the virtue of the Rehabilitation of Offenders Act 1974 (Exemptions) (Amendments) Order 1986 the provision of section 4.2 of the Rehabilitation of Offenders Act 1974 do not apply to any employment which is concerned with the provision of health services and which is of such a kind to enable the holder to have access to persons in receipt of such services in the course of his/her normal duties. You should there force list all offences below even if you believe them to be ‘spent’ or ‘out of date’ for some other reason.Right To WorkIt is a legal requirement that before any offer of work can be made all candidates provide the company with confirmation of their eligibility to work in the UK by providing one of the original documents detailed below. A passport which describes the holder as a British Citizen or as having a right of abode in the United Kingdom or a passport or other travel document to show that the holder has a Settled Status or an Indefinite Leave to Remain in the United Kingdom and is not precluded from taking the work in question. A passport or identity card issued by a State which is party to the European Union and EEA Agreement and which describes the holder as a national or a state which is a party to that agreement. A letter issued by the Home Office or the Department of Education and Employment indicating that the person named in the letter has permission to take agency work in question or a biometric residence permit. Work Time DirectivesIt is a legal requirement that before any offer of work can be made all candidates provide the company with confirmation of their eligibility to work in the UK by providing one of the original documents detailed below.* I DO NOT wish to work more than 48 hours per week I DO wish to work more than 48 hours per week Registration form DeclarationI declare that all information given in this registration form is to the best of my knowledge complete and accurate in all respects and that I am eligible to work in the UK. I understand that any false or misleading information may result in my removal from the register of members.Today's Date* DD slash MM slash YYYY Full Name:* Signature Reset signature Signature locked. Reset to sign again Privacy* By using this form you agree with the storage and handling of your data by this website as defined in our Privacy Policy * UntitledNameThis field is for validation purposes and should be left unchanged.
