Application Form

Mountain Healthcare - Job Application

Please complete the form below to apply for a position with us.
Full Name *

First Name Middle Name Last Name
Where did you see this vacancy advertised?
Other
Please indicate where you became aware of this role.
Do you possess registration with the HCPC, NMC or GMC?
Name in which your are registered with a professional body (if applicable)
Revalidation Date (if applicable)

Day Month Year
Professional Registration Number *
National insurance number *
Do you have a valid driving licence for the UK?
Current Address *

Street Address

Street Address Line 2

City County

Postcode Country
Email Address *
Phone Number *
Department of interest *
Location of interest (SARC) *
Location of interest (Custody) *
Other
Type Location of interest
Job Role of Interest
Other - Job Role of Interest
Type Job Role of interest
Are you a UK, EC (European Community) or EEA (European Economic Area) National? *
Preferred Employment Type

Full Time Part Time Job Share Zero Hours Self Employed

Previous employment

Please use this section to provide information about your previous employment starting with your current or most recent job.
Employment details (most recent) *

Company Your Job Title Email
Company Address

Street Address

Street Address Line 2

City County

Postcode Country
Employment start date *

Day Month Year
Employment end date *

Day Month Year
Responsibilities *
Reason for leaving *
Employment details (2) *

Company Your job title Email
Company Address

Street Address

Street Address Line 2

City County

Postcode Country
Employment start date *

Day Month Year
Employment end date *

Day Month Year
Responsibilities *
Reason for leaving *
Add more work experience?

Yes No
Employment details (3)

Company Your job title Email
Company Address

Street Address

Street Address Line 2

City County

Postcode Country
Employment start date

Day Month Year
Employment end date

Day Month Year
Responsibilities
Reason for leaving
Employment Gaps (if you've have any gaps within your employment history, please state the reasons and dates below) *

Education & Professional Qualities

Please use this section to provide information about your previous education including the qualifications/certificates your have gained.
Type *

Type Subject/Qualification Place of Study Grade/Result Year Obtained
Type

Type Subject/Qualification Place of Study Grade/Result Year Obtained
Type

Type Subject/Qualification Place of Study Grade/Result Year Obtained
Type

Type Subject/Qualification Place of Study Grade/Result Year Obtained
Type

Type Subject/Qualification Place of Study Grade/Result Year Obtained
Supporting Information

In this section you need to demonstrate that you have read the published person specification and how you meet the essential and (where relevant) desirable criteria for this particular post, if this has not been fully covered in the previous sections.

Please indicate your reasons for applying and take the opportunity to highlight your particular talents and strengths, (what you feel you can personally offer - what is unique to you - what sets you apart from your peers).

Please DO NOT include personal details or duplicate information already provided elsewhere in your application.
Add supporting information below

References Please use this section to provide a list of three professional references.

*References must cover a 3 year period of continuous employment, training or education. Your references will need to confirm this.

*Your referee could be an HR department or line manager.

*You must provide an Email address for each employee.

*Emails for employers must be a valid work email address and not the referee's personal email address.
Referee 1 *

Full name Relationship Email Address Company
Referee 2 *

Full name Relationship Email Address Company
Upload a copy of your CV

Browse Files
Uploading a CV is optional and your application will be considered equally regardless of whether or not you upload a CV. Cancel of

Safeguarding

Mountain Healthcare is committed to safeguarding, and promoting the welfare of the people we serve. Therefore, all successful candidates will subject to pre-employment checks, including an Enhanced DBS Check, Police Vetting and 2 satisfactory employment references

This section of the application form will only be viewed by those who need to see it as part of the recruitment process. The organisation will treat any information disclosed in the strictest of confidence.

You should read the Guidence relating to the Rehabilitation of Offenders Act 1974 (Exceptions) Order (as amended) to find out what you'll have to tell us. The Act deals with the fair treatment of ex-offenders and helping them into work. We'll refer to it in this part of the application.
Do you have any criminal convictions/cautions that are not protected, or are you currently the subject of any police investigation in the UK or abroad? *

Yes No
Are you currently the subject of any investigation or proceeding by anybody having regulatory functions in relation to health and social care professionals including a regulatory body abroad? *

Yes No
Have you ever been disqualified from the practice of a profession or required to practice it subject to specified limitations following a fitness to practice investigation by regulatory body abroad? *

Yes No
If you have answered YES to any of the questions above, please give further details.
DECLARATION: This information in this application form is true and complete. I agree that deliberate omission, falsification or misrepresentation in the application form will be grounds for rejecting this application or subsequent dismissal if employed by the organisation. Where applicable, I consent that the organisation can seek clarification regarding professional reference details. *

I agree

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Mountain Healthcare - Job Application