Veracity Healthcare Employment Application Form

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*

First NameLast Name
Date of birth *

DayMonthYear
Date
Gender*

FemaleMaleOther
Address*

Street Address

Street Address Line 2

CityState / Province

Postal Code
Email*
example@example.com
Phone Number*
Do you have the right to work in the UK?*
What type of Right to Work do you hold*

British or EU passport / birth certificate holderIndefinite Leave to Remain in UK (Permanent residence)Dependent visaStudent visaOn CoS Visa from another companyGraduate visaOther
NI Number (if you have one)
Please select role applied for *
Location you are applying for

Hull and East YorkshireNorth Yorkshire (Scarborough / Rydale)Scotland (Glasgow)
Please briefly explain what has made you apply for this role at Veracity Healthcare. You response may be assessed*
Do you have a DBS ?*
DBS Certificate Number
If yes, is the DBS on the Update Service?*
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?*

YesNoN/A ( my DBS is not on the Update Service)
DBS update reference (if applicable)
Do you hold a UK driving licence*
If you hold a UK driving licence, do have any driving convictions, penalty points or pending driving court cases etc*
If you have answered yes above, please give deatils of driving convictions, penalty points or pending driving court cases etc (indicate if N/A) *
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)*
Do you have a car you can use for work?*
Educational/Academic Qualifications

Please provide any relevant educational or professional qualifications you hold
Please indicate the highest relevant qualification (if applicable)*

I have NO formal qualificationsGCSE's'A Level'sCollege Certificate or DiplomaUniversity Degree/higher degreeProfessional qualification
Care Qualifications

Please provide any health and care qualifications you hold
Please indicate the health and care qualifications you have (if applicable)*

I have NO formal Health & Social Care qualificationsI have 'A Level' Health & Social Care qualificationsI hold a Care Certificate or NVQ Health & Social Care qualificationsI hold other care-related certificatesI am a Registered NurseI 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) *
E.g Care Worker / Driver/ Student
EMPLOYER NAME (Please indicate the name of employer) *
E.g Northwick Park Hospital (NHS) / Debenhams
DATES OF THIS EMPLOYMENT (Please indicate the dates you worked in this role/you were a student)*
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*
PREVIOUS EMPLOYMENT 1 (Please indicate role)*
E.g Care Worker / Driver
EMPLOYER (Please indicate the name of employer) *
E.g Northwick Park Hospital (NHS) / Debenhams
ROLES AND RESPONSIBILITIES Please give detail of the roles and responsibilities you held in this role*
DATES OF EMPLOYMENT (Please indicate the dates you worked in this role)*
E.g May 2018 - July 2021
Please state reason for leaving this role*
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)*
E.g Care Worker / Driver
EMPLOYER NAME (Please indicate the name of employer) *
E.g Northwick Park Hospital (NHS) / Debenhams
DATES OF EMPLOYMENT (Please indicate the dates you worked in this role)*
E.g May 2018 - July 2021
Please state reason for leaving this role*
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 *
E.g Northwick Park Hospital (NHS) / Debenhams
DATES OF EMPLOYMENT / EDUCATION (Please indicate the dates you worked in this role)*
E.g May 2018 - July 2021
Please state reason for leaving this role*
Please details the roles and responsibilities you held in this role *
ANOTHER EMPLOYMENT / EDUCATION (if information you provided does not cover 10 years period)*
E.g Care Worker / Driver
EMPLOYER NAME (Please indicate the name of employer) *
E.g Northwick Park Hospital (NHS) / Debenhams
DATES OF EMPLOYMENT (Please indicate the dates you worked in this role)*
E.g May 2018 - July 2021
Please details the roles and responsibilities you held in this role *
EMPLOYMENT GAPS (Please give details of other employment or gaps in employment in the last 10 yeras in this section (if applicable) *
Health & social care work experience

Please provide information about relevant work experience
Please indicate any relevant work experience (if applicable)*

I have NO experience of working as a nurse or carer in the UKI have experience of working as a carer in the UKI have experience working as a nurse in the UKI have experience working as nurse OUTSIDE OF THE UKI 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?*

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)?*

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?*

Full-time employmentPart-time employmentBank work (as and when you or the work is available)Health & social care college studentVoluntary 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)?*

YesNo (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*

I am ready to startIn the next 2 weeksIn the next 6 weeksIn 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)*

First NameLast Name
1st Referee's Email*
example@example.com
Name of Compnay / Educational institution this applies to (otherwise indicate N/A) *
example@example.com
1st Referee's Telephone Number
Referee's Address (not required if you provided email)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
REFEREE 2 (character referee)*

First NameLast 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

CityState / 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 ?*

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?*

YesNo
Please inform us how you got to hear about the job you are applying for*

From an employee of this companyFrom another personFrom a facebook advertFrom a flyer at the local store/GP/PharmacyFrom Indeed websiteFrom this company's websiteFrom a job fair
Should be Empty:

Application for Employment

Personal details

Educational/Academic Qualifications

Care Qualifications

Employment History (Section A)

Employment History (Section B)

Health & social care work experience

Health and Physical Ability to Perform Care Duties

Communicable Infections / Diseases

Type of contract

Shift working

Availability

References