Application Form

Application Form

Please complete this form as fully and as accurately as possible. If you have any problems with the form, or need to forward additional supporting information, please drop us an email at enquiries@primaryambulanceservices.co.uk
Position Applied For:*
If responding to a specific vacancy, please also put the Vacancy Code here.
Which Type of Contract are you Looking For:*

Full Time (38-40hrs Per Week) - We are a 24hr Per Day, 365 Days per Year Service, so you would be expected to be available to work Days, Nights and Weekends as Service Demands Dictate.Part Time (16-20hrs Per Week) - We are a 24hr Per Day, 365 Days per Year Service, so you would be expected to be available to work Days, Nights and Weekends as Service Demands Dictate.Bank/Zero Hours (Shifts would be offered to you via our "Shift-Planning" System, you would be required to undertake a minimal amount of shifts per month.Other
Have you ever applied for employment, or worked for Primary Ambulance Services before?*

YesNo
If Yes, to the Question Above, please state where, when and in what capacity:
Personal Information
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*

Area CodePhone Number
Email*
example@example.com
Do you hold "The Right To Work in the UK"?*

YesNo
Have you held a FULL UK (Manual) Driving License for more than 2 Years?*

YesNo
Personal Statement

Tell us a little about yourself, what makes you tick?
Tell us a little about yourself.. Personal statement*
Who are you, What do you like/dislike, Current Abilities, Aspirations for the Future
Please tell us why you've applied for this role and why you think you are suited to it:
General Education and Training
Please include details of your current qualifications, including any full/part time courses including apprenticeships, correspondence courses and vocational qualifications:*
Please include "Subjects Studied/Course Title", "Qualification Achieved", "Grade Attained"
Convictions and Legal Proceedings

Please read carefully and select the correct options.
Ex-offenders will be considered for employment on their merit. Under the Rehabilitation of Offenders Act 1974, you are not required to enter details of any offences which are spent under the terms of the act. However, if you are applying for a position that has regulated activities, such as a PTS Care Assistant, you will be subject to an enhanced DBS check. You must give details of any convictions, cautions, reprimands and final warnings that are not protected under the DBS filtering rules as defined by the Rehabilitation of Offenders Act 1974 (exceptions) order 1975 as amended in 2013. The amendments to the Exceptions Order 1975 (2013) provide that certain spent convictions and cautions are ‘protected’ and are not subject to disclosure to employers and cannot be taken into account.

You hereby agree to a full disclosure to the company and/or any Trust as required. The company will carry out background checks either directly or via an agency into the suitability where you may be required to work with vulnerable groups (such as children, the elderly or the infirm). Primary Ambulance Services, from time to time, may register an interest with the DBS online for legitimate business reasons and may carry out an online check on your status and receive updates seeking to understand whether an employee’s status changes. You consent to this disclosure.

Where it is found that an individual has intentionally provided inaccurate information or withheld information relevant to their position, this may disqualify them from appointment.

If you are unsure what information may be disclosed on your DBS Check, please visit filtering rules for criminal record checks on www.gov.uk
Have you ever been Convicted or Cautioned for a Criminal or Motoring Offence? (Select all relevant options)*

I have NOT been Cautioned nor Convicted for a Criminal or Motoring Offence.I have been Cautioned/Convicted for a Motoring Offence and have given further details below.I have been Cautioned/Convicted for a Criminal Offence and have given further details below
Please give further details:
Including Dates of Convictions and Sentence/Endorsements Given)
Employment Details

Please include details of present or most recent employment and all employment over the last 5 years. Include any periods of voluntary work, caring, homemaking or unemployment in this sections, with dates. References will be sought as appropriate.
Current or Most Recent Employer's Name:*
Current or Most Recent Employer's Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Current or Most Recent Employer Email Address*
example@example.com
Current or Most Recent Employer Phone Number*

Area CodePhone Number
Employment Start Date (Most Recent Employer)*

MonthDayYear
Date
Employment End Date (Most Recent Employer)*

MonthDayYear
Date

Previous Employment Details

	Previous Employer (1)	Previous Employer (2)	Previous Employer (3)	Previous Employer (4)
Employer Name
Employer Address
Employer Email
Employer Tel
Start Date
Leaving Date
Job Title/Role
Responsibilities

Supporting Information

Here's your opportunity to upload and attach to your application, any information with would support your application, such as Certificates, CV, Personal Statement, Existing DBS (If on Update Service) and any other relevant information. Further information can also be emailed to enquiries@primaryambulanceservices.co.uk.
Upload your CV, Certificates and Supporting Information:

Browse Files
CV, Certificates, Driving License, Passport Copy, DBS and anything else relevant to your application. Cancelof
GDPR Consent

Please read carefully.
Primary Ambulance Services Ltd takes your privacy seriously and will use your personal information for the necessary administration of yourself and to ensure your ongoing compliance with company policies.

Additionally, Primary Ambulance Services will use your information to demonstrate compliance with:

• Contractual requirements with NHS and Local Authority Clients
• Contractual requirements with Private clients (Specific list can be supplied if required / requested)
• Organisations such as the Care Quality Commission (CQC), Information Commissioners Office (ICO), Revenue and Customs or any other government body with a legitimate legal requirement to do so.
• Legal consultancy
• Your chosen union representative / body.
Please confirm that you give consent for Primary Ambulance Services to communicate your details as defined above in the following manners:

MailEmailTelephoneSMS (Text) MessageAutomated Call
Why are we doing this?
Primary Ambulance Services is doing this because of new legislation which requires that you are given genuine control of YOUR data. This requires that you give your implicit, informed consent and that you have the absolute right to know what information is held about you and to have that information corrected or deleted if it is wrong. That being said Primary Ambulance Services is required to maintain certain records to meet legal requirements (some of the agencies are mentioned above)

You may withdraw your consent where the information is held without a “lawful basis for processing” at any time.

• Primary Ambulance Services will retain this record of your consent.
• Primary Ambulance Services will regularly review your consent to check that the relationship, the processing and the purposes have not changed.
• Primary Ambulance services will only retain your information as long as it has a legal basis to do so.

If you wish to consent please sign below:
Name*

First NameLast Name
Signature

Clear
Equality and Diversity Monitoring

We need your help and co-operation to enable us to do this, but filling this part of the form is voluntary.
Primary Ambulance Services wants to meet the aims and commitments set out in its equality policy. This includes not discriminating under teh Equality Act 2010, and building an accurate picture of the make-up of the workforce in encouraging equality and diversity.
Gender

MaleFemaleTransitioningNon-BinaryPrefer Not to SayOther
Are you Married or in a Civil Partnership?

YesNoPrefer Not to Say
Age:

18-2425-2930-3435-2940-4445-4950-5455-5960-6465+Prefer Not to Say
What is your ethnicity?
Ethnic origin is not about nationality, place of birth, or citizenship, It is about the group to which you perceive you belong.
Do you consider yourself to have a disability or health condition?

YesNoPrefer Not to Say
What is the effect or impact of your disability or health condition on your ability to give your best at work? Please write below:
The information in this form is for monitoring purposes only. If you believe you need a 'reasonable adjustment', then please discuss this with the Primary Ambulance Services team.
What is your sexual orientation?

HetorosexualHomosexualBisexualPrefer Not to SayOther
What is your religion or belief?

No Religion or BeliefBuddhistChristianHinduJewishMuslimSikhPrefer Not to SayOther
Do you have any caring responsibilities?

NonePrimary Carer of a Child/Children (Under 18)Primary Carer of Disabled Child/ChildrenPrimary Carer of Disabled Adult (18 and Over)Primary Carer of Older PersonSecondary Carer (Another person carries out the main caring role)Prefer Not to Say
Declaration
I declare that the information provided on this application form is, to my knowledge true and accurate. I understand that if it is subsequently discovered that any statement is false or misleading, I may be discharged from employment with Primary Ambulance Services Limited. With the exception of offences, which are “spent” under the terms of the “Rehabilitation of Offenders Act 1974”, I have included details of criminal or court martial convictions, including driving convictions.

I understand that it will be necessary to undergo a Disclosure and Barring Service check, which will ask exempted questions under the “Rehabilitation of Offenders Act 1974” and will show offences that are “spent” under the act.

I agree to a driving assessment, eyesight and drugs test to assess my fitness to carry out the essential driving functions of the role, and acknowledge that if I fail any of these tests my employment may be terminated.

I am legally entitled to take paid employment in the United Kingdom. I consent to Primary Ambulance Services Limited seeking references from my previous employer.

Electronic data relating to applications for employment is stored for a maximum of 6 months. If you wish your individual data to stop being processed prior to that please write to the HR department making that request.
Please mark to confirm that you have read and understood the above statement*

Confirmed
THANK YOU FOR COMPLETING THIS APPLICATION. YOU ARE ASSURED THAT IT WILL BE TREATED IN THE STRICTEST CONFIDENCE.

IF YOU SUCCESSFULLY PASS THIS STAGE OF OUR RECRUITMENT PROCESS, A MEMBER OF OUR TEAM WILL BE IN TOUCH TO PROGRESS YOUR APPLICATION TO THE NEXT STAGE.

Whilst we do endeavour to respond to all applicants, If you do not hear from us within 14 days of submitting your application, please assume you have been unsuccessful on this occasion. Unsuccesful candidates will become eligible to re-apply for a position within Primary Ambulance Services after a period of six months.
Should be Empty:

Application Form

Personal Information

Personal Statement

General Education and Training

Convictions and Legal Proceedings

Employment Details

Supporting Information

GDPR Consent

Why are we doing this?

Equality and Diversity Monitoring

Declaration