Application for Employment
Personal details
The information you provide to us is processed in line with Data Protection Act 2018 (The UK's implementation of the General Data Protection Regulation (GDPR).
Name
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First Name
Last Name
Date of birth
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-
Day
-
Month
Year
Date
Gender
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Female
Male
Other
Address
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Street Address
Street Address Line 2
City
State / Province
Postal Code
Email
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example@example.com
Phone Number
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Do you have the right to work in the UK?
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Please Select
Yes
No
What type of Right to Work do you hold
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British or EU passport / birth certificate holder
Indefinite Leave to Remain in UK (Permanent residence)
Dependent visa
Student visa
On CoS Visa from another company
Graduate visa
Other
NI Number (if you have one)
Please select role applied for
*
Please Select
Administrative Assistant
Apprenticeship
Care Worker (not a driver)
Carer Worker (who drives)
Care Cordination Assistant
Driver
Quality Practitioner
Please briefly explain what has made you apply for this role at Veracity Healthcare. You response may be assessed
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Do you have a DBS ?
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Please Select
Yes
No
DBS Certificate Number
If yes, is the DBS on the Update Service?
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Please Select
Yes
No
N/A if you have no DBS
If your DBS is on the Update Service, do you give us permission to check your DBS if we are considering shortlisting you for interview?
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Yes
No
N/A ( my DBS is not on the Update Service)
DBS update reference (if applicable)
Do you hold a UK driving licence
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Please Select
Yes
No
If you hold a UK driving licence, do have any driving convictions, penalty points or pending driving court cases etc
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Please Select
Yes
No
I dont have a driving licence
If you have answered yes above, please give deatils of driving convictions, penalty points or pending driving court cases etc (indicate if N/A)
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Do you hold a valid foreign licence that you can use to drive in the UK (to check visit: https://www.gov.uk/driving-nongb-licence)
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Please Select
Yes
No
N/A
Do you have a car you can use for work?
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Please Select
Yes
No
Educational/Academic Qualifications
Please provide any relevant educational or professional qualifications you hold
Please indicate the highest relevant qualification (if applicable)
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I have NO formal qualifications
GCSE's
'A Level's
College Certificate or Diploma
University Degree/higher degree
Professional qualification
Care Qualifications
Please provide any health and care qualifications you hold
Please indicate the health and care qualifications you have (if applicable)
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I have NO formal Health & Social Care qualifications
I have 'A Level' Health & Social Care qualifications
I hold a Care Certificate or NVQ Health & Social Care qualifications
I hold other care-related certificates
I am a Registered Nurse
I am a Registered Allied Professional (e.g Social Worker, Physiotherapist, OT e.t.c)
If you are a registered professional (e.g nurse, OT,Social worker etc please indicate your registration number) Please state N/A if not applicable
Employment History (Section A)
Please give details your employment history in the last 10 years (including self-employment). If the employment history you give in this section does not cover 10 years, you will also be required to complete Section B
CURRENT / MOST RECENT EMPLOYMENT (or EDUCATIONAL INSTITUTE if your most recent occupation is that of a student) (Please indicate role)
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E.g Care Worker / Driver/ Student
EMPLOYER NAME (Please indicate the name of employer)
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E.g Northwick Park Hospital (NHS) / Debenhams
DATES OF THIS EMPLOYMENT (Please indicate the dates you worked in this role/you were a student)
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E.g May 2018 - July 2021
ROLES AND RESPONSIBILITIES IN THIS EMPLOYMENT Please give detail of the roles and responsibilities you held in this role
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PREVIOUS EMPLOYMENT 1 (Please indicate role)
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E.g Care Worker / Driver
EMPLOYER (Please indicate the name of employer)
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E.g Northwick Park Hospital (NHS) / Debenhams
ROLES AND RESPONSIBILITIES Please give detail of the roles and responsibilities you held in this role
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DATES OF EMPLOYMENT (Please indicate the dates you worked in this role)
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E.g May 2018 - July 2021
Please state reason for leaving this role
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PREVIOUS EMPLOYMENT 2 (please indicate most recent role in the over 5 years period. If you provided 5 year history above indicate N/A in this section)
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E.g Care Worker / Driver
EMPLOYER NAME (Please indicate the name of employer)
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E.g Northwick Park Hospital (NHS) / Debenhams
DATES OF EMPLOYMENT (Please indicate the dates you worked in this role)
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E.g May 2018 - July 2021
Please state reason for leaving this role
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Employment History (Section B)
If your employment history above does not cover the last 10 years you will need to complete this section. If you are/were a student, please indicate in the 'role section' that you were a student, the dates you were a student, and indicate your studies in the 'role detail' section. If you have already provided 10 years working/educational history indicate (N/A 10 year history already provided above) in all sections below
EMPLOYER (or EDUCATIONAL INSTITUTION) NAME
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E.g Northwick Park Hospital (NHS) / Debenhams
DATES OF EMPLOYMENT / EDUCATION (Please indicate the dates you worked in this role)
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E.g May 2018 - July 2021
Please state reason for leaving this role
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Please details the roles and responsibilities you held in this role
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ANOTHER EMPLOYMENT / EDUCATION (if information you provided does not cover 10 years period)
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E.g Care Worker / Driver
EMPLOYER NAME (Please indicate the name of employer)
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E.g Northwick Park Hospital (NHS) / Debenhams
DATES OF EMPLOYMENT (Please indicate the dates you worked in this role)
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E.g May 2018 - July 2021
Please details the roles and responsibilities you held in this role
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EMPLOYMENT GAPS (Please give details of other employment or gaps in employment in the last 10 yeras in this section (if applicable)
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Health & social care work experience
Please provide information about relevant work experience
Please indicate any relevant work experience (if applicable)
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I have NO experience of working as a nurse or carer in the UK
I have experience of working as a carer in the UK
I have experience working as a nurse in the UK
I have experience working as nurse OUTSIDE OF THE UK
I have experience working as an allied health professional in the UK (e.g Social Worker, Physiotherapist, OT e.t.c)
Health and Physical Ability to Perform Care Duties
This role may involve physically demanding tasks such as assisting individuals with mobility, personal care, and manual handling (e.g., lifting, repositioning, using hoists). To ensure the safety and wellbeing of both staff and service users, please let us know if you have any health condition, disability, or medical issue that may affect your ability to carry out these duties
Do you have any medical condition or disability that may impact your ability to perform the physical elements of this role?
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Yes (if you answer––we will request for more informtion (Confidentially)
No
Communicable Infections / Diseases
As this role involves working with vulnerable individuals, we have a duty to protect the health and safety of both service users and staff. In line with infection prevention policies, we ask that you disclose any communicable diseases or infections that may pose a risk to others in a care setting.
Do you currently have a communicable disease that may affect your ability to safely work in a care environment or pose a risk to service users (e.g., Covid, Tuberculosis, Hepatitis B/C, or similar)?
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Yes(if you answer––we will request for more informtion (Confidentially)
No
Type of contract
Please indicate the contract you are looking for
Please indicate what type of contract you want us to consider you for?
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Full-time employment
Part-time employment
Bank work (as and when you or the work is available)
Health & social care college student
Voluntary work
Shift working
To ensure fairness and a healthy work-life balance for all team members, we operate a rota-based work schedule. This includes working some weekends and having other weekends off, on a rotating basis.
Are you able to commit to working on a rota that includes alternate weekends (i.e., working some weekends and having others off)?
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Yes
No (If you answer no please provide details below)
Please explain you answered no above
Availability
If your application was accepted, when would you be available to start?
Type a question
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I am ready to start
In the next 2 weeks
In the next 6 weeks
In the next 3 months
References
Please provide two referees who can provide a references for you.
REFEREE 1 (your last employer if you are / were employed before - if not provide another character referee)
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First Name
Last Name
1st Referee's Email
*
example@example.com
Name of Compnay / Educational institution this applies to (otherwise indicate N/A)
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example@example.com
1st Referee's Telephone Number
Referee's Address (not required if you provided email)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
REFEREE 2 (character referee)
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First Name
Last Name
2nd Referee's Email
*
example@example.com
2nd Referee's Telephone Number
Refereee's Address (not required if provided email)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please note that we will not accept a reference from your relative. In view of that, please confirm that you are not related to the individulas you have listed as referees ?
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I confirm that I am not related to any of the inividulas I have listed as refreees in this application
Are you happy for us to request for your references before your interview?
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Yes
No
Please inform us how you got to hear about the job you are applying for
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From an employee of this company
From another person
From a facebook advert
From a flyer at the local store/GP/Pharmacy
From Indeed website
From this company's website
From a job fair
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