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  • Registration Form

  • Contact Details

  • Next of Kin

    Emergency Contact Details

  • Education & Employment History

    Please upload a CV, this must contain dates from and to (MM/YY) for your full education history and last 10 years employment history. If you do not have a CV please provide full details below.
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    • If you do not have a CV, don't worry please click and complete below 

    • Employment History

      Complete full 10 year employment history or from school leaving age if less than 10 years.
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  • Professional References

    Healthcare Staff Recruitment require a minimum of two professional references that must cover your last 3 years employment history. We can only accept references from work email addresses. We can only accept references from employers that currently work at your previous employer. If you have been in full time education within the last 3 years then please provide your tutor / lecturer. If you have worked for your current employer for the last 3 years then you can provide a character reference as your second reference. If you are providing a character reference they must not be related to you and have known you for a minimum of three years.

  • Reference 1

  • Reference 2

  • Declaration of Criminal Record & Professional Investigation

    Your role is exempt from the Rehabilitation of Offenders Act, therefore you must disclose all spent and unspent convictions and cautions. However, under new filtering rules (2013) - certain offences may be removed from your criminal record, please see DBS website for more information. If you do not declare a conviction/caution/reprimand that later appears on your DBS this could result in dismissal or unsuccessful registration. Please note that if at any stage whilst working for Healthcare Staff recruitment we receive a DBSEnhanced Disclosure that highlights information you have not declared, then you will be removed from your assignment.

  • Working Time Directive

    The Working Time Regulations place a limit on the average number of hours per week that can be worked.  If you are prepared to work more than the stipulated average hours per week and therefore opt out of the WTR agreement,  please indicate by signing below:
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  • Declarations

  • 1.     I confirm that I have read this document fully and that all the information given to Healthcare Staff Recruitment is correct to the best of my knowledge and belief. I understand that a false declaration may lead to refusal of this application. If, while I am working with Healthcare Staff Recruitment, any of the information provided changes, I agree to notify Healthcare Staff Recruitment Healthcare in writing immediately.

    2.     I understand and agree to Healthcare Staff Recruitment disclosing this information to their clients for the purpose of finding me assignments. I have read, understood and accept the information contained within the Staff Handbook I have read and agree to adhere to the Healthcare Staff Recruitment Terms of Engagement I understand that if I am charged or cautioned after signing this declaration, I must inform Healthcare Staff Recruitment immediately.

    3.     I acknowledge and confirm that Healthcare Staff Recruitment is authorised to conduct pre-employment checks including but not exclusively Disclosure and Barring Service Check, References, Right to work checks for the purposes of my registration and on-going compliance for Healthcare Staff Recruitment to continue to offer me assignments . 

    4.     I acknowledge that my personal details will be stored and handled correctly by Healthcare Staff Recruitment in accordance with the Data Protection Act 2018 however, I agree that they may be made available for audit/review by relevant third parties.

    5.     I agree that as part of the application process, I will meet with Healthcare Staff Recruitment to have my identity and my original documents verified and agree to all Occupational Health and Pre-Employment Requirements.

    6.     I agree that any uniform provided to me is looked after, always clean, well ironed and work correctly. Upon termination I will return all uniforms and ID Badge to Healthcare Staff Recruitment. Failure to do so will result in a cost deduction from my final wage.

    7.     I agree that my contact details will be used for the purposes of offering me assignments and company communication relevant to my role, this will include SMS, Email, Phone and Post.

    8.     I understand that I must maintain the relevant checks and undertake mandatory training for me to maintain my registration and be offered assignments from Healthcare Staff Recruitment

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