Crest Care Solutions Application Form

Application Form
Crest Care Solutions Ltd Equal Opportunities Policy covers all employees, or potential employees, and embraces the principle that all people shall be treated equally, regardless of their age, gender, ethnic origin, nationality, colour, religion, marital status, sexual orientation, religion or belief, disability, or offending background. Crest Care Solutions Ltd, 400 Thames Valley Park Drive, Reading, Berkshire, England, RG6 1PT Data Protection Act 1998: By filling in this form, you give us the right, under the Data Protection Act 1998 to process the information you have given, including data of a sensitive nature, relating to your application for employment. Any processing of the data by us will be in accordance with our Policy and the processing principles set out in the Act.
Position Applied For *
Title
First and Last Names *

First Name Last Name
Middle Name
Previous Name
Date of Birth

Month Day Year
Date
Address *

Street Address

Street Address Line 2

City Post Code

County
Phone Number

Area Code Phone Number
Telephone:
Email
example@example.com
Insurance Number
Pin Number(Qualified Nurses Only)
Vacancy: Where did you hear of this vacancy
Are you currently permitted to work in UK?

Yes No
Do you currently have a DBS on the DBS Server Update service??

Yes No
If Yes, what is the DBS Update Service reference number
if No, Do you agree to submit the fees in advance for DBS disclosure

Yes No

Rehabilitation of Offenders
Failure to disclose any convictions which are not "spent" may render your liable for dismissal
Have you any convictions which are not regarded as “spent” Under the Rehabilitation of Offenders Act 1974? Yes/No (If “yes”, describe the offence and date of conviction)
Are you currently the subject of any criminal proceedings or convictions? Yes/No (If Yes, please state)

Declaration by job applicant
Declaration:
I have read and understood the information supplied to me in relation to this Job Position, and the information requested in this Job Application Form.
I confirm that all information supplied by me is true and correct to the best of my beliefs.
I give consent for a third party, to view my employment file for compliance or inspection purposes I authorise Amflo Care Services Ltd, to pay my wages, directly into my bank account, details of which I have given on this form I give the prospective employer the right to follow up all references, and to make any other job-related enquiries as may be deemed necessary.
Date

Month Day Year
Date
Signature

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I agreed to abide by the following clauses:
I will maintain the confidentiality of all the service user records and any other information that involves their care / medical management of the patient.
I shall not disclose service user information in any manner that causes any harm to the service user or the relatives of the service user in any manner.
I shall keep all medical history records / information which include papers, images, and reports of the patient in a confidential manner.
I shall maintain confidentiality with regard to the verbal discussion and observation about the patient.
I shall withhold all personal information of the patient such as social security number, telephone number, mailing address, spouse details, key safe code etc.
I understand that unauthorized release of patient information to those who need not know it will make me liable for legal prosecution and disciplinary action by my employer as well.
Declaration:
By putting my name below(signing) i agree to have read and understood all the clauses specified above and the patient has right to take action against me.
Date

Month Day Year
Date
Signature

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Application Form