Jobmerger Employment Application Form

Jobmerger Employment Application

Fill the form below accurately indicating your potentials and suitability to job applying for.
Take Photo*
Name:*

First NameLast Name
Birth Date*

MonthDayYear
Phone Number:*

Area CodePhone Number
E-mail Address:*
National Insurance Number :*
Address:*

Street Address

Street Address Line 2

CityCounty

Post Code
Nationality :*
Do you require a permit to work in the UK?*
what is your work permit number?
Passport number (applicants from United Kingdom and Northern Ireland ) *
Are you a car driver? *
Do you hold a current UK driving licence ?*
If you do not have a UK driving licence , Please indicate option that applies to you
Do you have a Current DBS ? ( This is Required if you are applying for a job in healthcare)

YesNoAwaiting Certificate
If yes What is your DBS number?
If Yes , have you registered DBS on the update service?

YesNo
If no, are you happy for us to apply for a DBS on your behalf? (This comes at a cost of £70)

YesNo
NEXT OF KIN
Next Of Kin*

First NameLast Name
Next of Kin contact Number

Area CodePhone Number
Address Of Next of Kin

Street Address

Street Address Line 2

CityCounty

Post Code
Relationship to you
AVAILABILITY AND PREFFERED HOURS
Prepared to work

Full timePart timeDay ShiftsNight Shifts
Details of any other job which you will continue to undertake if offered this position
Available to take up employment from

MonthDayYear
Date
EXPERIENCE (please tick where applicable)

care of the elderlyuse of hoistsfeedinglearning disabilitiesincident reportingcare plansdomicilliary careresidential caremoving and handlingmeal preparationfood handlingpersonal careobservingbed bathingnursing home
Please list any Professional qualifications you have achieved and dates completed
Work History
Company Name 1:*
Role/Position *
From Date* To Date*
Responsibilities *
Reason For Leaving*
Company Name 2:*
Role/Position *
From Date* To Date*
Responsibilities *
Reason For Leaving*
Company Name 3:
Role/Position
From Date To Date
Responsibilities
Reason For Leaving
Do you have any gaps in employment? Please give a brief explanation to these gaps(N/A if not applicable) *
Have there been any proceedings of medical negligence or professional misconduct against you that lead to suspension or dismissal?*

YesNo
If yes please supply details
BANK DETAILS
Account holder name
Name of Bank
Account number
Sort Code
CRIMINAL BUREAU

If the position you are applying for (whether paid or voluntary) is listed in Schedule 1, Part II of the Rehabilitation of Offenders Act (Exceptions) Order 1975, we are entitled to ask Exempted Questions as defined by Section 113(5) of the Police Act 1997 about you. We are required to acquire a Criminal Record Certificate in relation to any person who is a Care Manager or Care Worker. This means that if your application is successful we will obtain through the Disclosure & Barring Service (DBS) an Enhanced Criminal Record Certificate relating to you before your appointment is confirmed.

Having a criminal record will not necessarily bar you from working with us. This will depend upon the nature of the position and thecircumstances and background of your offences. We observe the “Code of Practice for Registered Persons and Other Recipients of DisclosureInformation” published through the Disclosure & Barring Service on behalf of the Home Office, and we will provide you with a copy of it upon request.
CONVICTIONS
Do you have any unspent criminal convictions ?*

YesNo
If yes please give details
WORKING TIME DIRECTIVE
The working time regulations are guidelines of Health and Safety at work measures stipulating safe working hours set by the European Union in the Time Directive of 1993 and these regulations came into effect in October 1998. The current limit for an average working week is 48 hours and no one is under any obligation to accept to work more than the stipulated hours and under any circumstances will anyone be compelled to do this unless they wish to do so. Please could you sign below as proof that you have read and understood the above regulations and whether or not you will be willing to work more than 48 hours, if further clarification is required please speak to one of our consultants who will supply you with more information regarding this regulation. A copy of this form will be given to you for your records.
Do you wish to work more than 48 hours per week?

YesNo
Signature

Clear
DISABILITY
The information in this section will be disclosed to the Recruiting Manager if you are short listed for interview. Under the Disability Discrimination Act 1995, a person has a disability if he or she has a physical or mental impairment which has a substantial and long-term adverse effect on his or her ability to carry out normal day-to-day activities
Do you consider yourself as having a disability*

YesNo
If yes , Please give details including disability number if applicable
EQUAL OPPORTUNITIES

Jobmerger Recruitment LTD operates an equal opportunities policy aimed at giving everyone the same privileges and opportunities. All employees will be judged on their capabilities rather than gender, race, religious or political beliefs. At Lime Healthcare we will take seriously any complaints or allegations of discrimination in any form against any of our staff or clients. We will investigate and notify authorities and take appropriate action where necessary. The questions are designed in helping us to monitor our workforce and implement any way possible to allow us to be a representative of the community as a whole by targeting any deprived or misrepresented groups. Please take a few moments to fill in the information required below.
Please indicate your Ethnic origin

WhiteMixedBlack or Black BritishAsian or Asian BritishOther EthicI do not wish to disclose my ethnic group
CONFIDENTIALITY AND DATA PROTECTION

Jobmerger LTD complies with all Codes of Conduct set aside by the Government and all other relevant organizations, we also adhere to the Data Protection Act of 1998 and the release of any personal details concerning you, client or any work related matter without the consent of the relevant individuals is strictly prohibited. The data provided on this form will be stored in compliance with the Data Protection Act 1998 and you will be able to access the information through the Subject Request Procedure
How were you referred to us?*

Walk-InEmployee ReferralIndeedFacebookTwitterOther (please specify)
Others:
Upload Resume:*

Upload a File

Cancelof
References

Please list two (2) references that are familiar with your work life.
Reference 1 ( Must be your most recent employer )
Name:*

First NameLast Name
Phone Number*

Area CodePhone Number
Company / Institution*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Position*
Date Employed from : mm/yy*
Date Employed To : mm/yy*
Years Known:*
Email*
example@example.com
Reference 2
Name:*

First NameLast Name
Phone Number*

Area CodePhone Number
Company / Institution*
Position*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Date Employed from : mm/yy*
Date Employed To : mm/yy*
Years Known:*
Email*
example@example.com
DECLARATION

I confirm that all the information and statements l have provided above are all true to the best of my knowledge and do understand that any misrepresentation by myself knowingly on any part of the application will result in it being invalid and if employed could result in my dismissal. I am prepared for the Agency to carry out any checks necessary including a Police check.

I hereby give Jobmerger access to my personal files as part of any official audit or client compliance procedures. Proof of identity will be viewed and photocopied in accordance with the requirements of the data protection act 1998.
NAME ( please print):*
Signature

Clear
Should be Empty:

Jobmerger Employment Application

NEXT OF KIN

AVAILABILITY AND PREFFERED HOURS

BANK DETAILS

CRIMINAL BUREAU

CONVICTIONS

WORKING TIME DIRECTIVE

DISABILITY

EQUAL OPPORTUNITIES

CONFIDENTIALITY AND DATA PROTECTION

DECLARATION