Application Form

Position Applying For*
Professional Application:
Full Name*

First NameMiddle NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*

Area CodePhone Number
E-mail*
Birth Date*

DayMonthYear
YesNo
YesNo
Distance Willing To Travel?*

Employment Desired:
Current Occupation*
Years Experience
Date You Can Start*

MonthDayYear
Other Position Not Listed

Education:
High School
Name of High School Attended
Number of Years Attended
YesNo
College
Name of College/University Attended
Number of Years Attended
YesNoSome College
Area of Study/Degree
Graduate School
Name of Graduate School Attended
Number of Years Attended
Yes
Area of Study/Degree
Skills/Qualifications:
Skills*
List any relevant skills
Qualifications*
List any relevant certifications or qualifications

Current Employment:
Current Employer*
Name of Current Employer or NONE if not Employed
Position*
Start Date

MonthDayYear
YesNo
Previous Employment:
Previous Employer*
Name of Previous Employer
Position*
Salary
Reason for Leaving?
Start Date

MonthDayYear
End Date

MonthDayYear
Previous Employer
Name of Previous Employer
Position
Salary
Reason for Leaving?
Start Date

MonthDayYear
End Date

MonthDayYear

References:

Reference Details Please give details of two or more of your current and previous employers to which references can be made, covering at least three full years (Including any Agency Employment). References must be by Employer /Senior Healthcare Professionals, and must come from a business address.
Current /Most Recent Employer*
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date Employed From

MonthDayYear
Date
Date Employed To

MonthDayYear
Date
Referees Name*
Position*
Referee Phone Number*
Referee Email Address*
Previous Employer
Company Name*
Name of Reference
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date Employed from

MonthDayYear
Date
Date Employed To

MonthDayYear
Date
Position*
Referee Phone Number*
Referee Email*
Character Referee
Referee's name*
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Referee Phone Number*
Referee Email*

Resume*

Browse Files

Cancelof
Required Infomation

Kays Recruitment Ltd recognises its duty to recruit staff under the legal parameters of the Equality Act 2010, however we need to establish your ability to undertake the core fundamental duties in the role you will be undertaking. Please therefore answer the following honestly and accurately:
Do you consider yourself fit to carry out the day to day duties that would be required of your role as a Health Care Assistant. The general day to day tasks are listed within the Skills list that you have completed as part of this application? If no – you will be asked to provide us with a separate confidential statement which will be forwarded on to our HR Department for risk assessment and review. *
Do you have any convictions, cautions, reprimands or final warnings that are not “Protected” as defined by the Rehabilitation of offenders Act 1974 (Exceptions) Order 1975, as amended in 2013? If yes, please give further details on a separate confidential statement including date(s) of convictions and nature of the offence(s). Please note that only relevant convictions will be taken into account so disclosure need not necessarily be a bar to obtaining employment *
Have you ever been dismissed or suspended from any post as a result of safeguarding issue? Or are you currently under any investigation as a result of conduct or performance? *
GDPR I consent as an Agency Worker, that we (Kays Recruitment Ltd) will collect personal data from you in order to fill our contract with you, to comply with our legal obligation and to provide you with work with our clients. This includes information you have given us on this form and in attachments you provide. The information we collect will be used by us to progress your application with us, and/or to fulfil legal and regulatory obligations. The information we asks help us to assess your suitability for work. You don't have to provide us with the information we ask but it may affect our ability to provide you work if you do not. Some of the information will be shared with our clients to enable us to provide you the opportunity to work with them*
Send Application:
By clicking the submit button below, I cerity that all of the information provided by me on this application is true and complete, and I understand that if any false information, ommissions, or misrepresentations are discovered, my application may be rejected and, if I am employed by one of our affiliates, my employement may be terminated at any time.

In consideration of my employment, I agree to conform to the hired company's rules and regulations, and I agree that my employment and compenstation can be terminated, with or without cause, and with or without notice, at any time, at either my or the company's option.

I also understand and agree that the terms and conditions of my employment may be changed, with or without cause, and with or without notice, at any time by the company.
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Professional Application:

Employment Desired:

Education:

Skills/Qualifications:

Current Employment:

Previous Employment:

References:

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