Total Healthcare Solutions Job Application Form

Total Healthcare Solutions Job Application

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

First NameMiddle NameLast Name
Current Address

Street Address

Street Address Line 2

CityCounty

PostcodeCountry
Date of Birth

DayMonthYear
Email Address
example@example.com
Phone number
Applying for Position
National insurance number
Are a citizen of the UK/EEA?
If no, are you authorized to work in the UK/EEA?

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

CompanySupervisorPhone numberEmailJob title
Company Address

Street Address

Street Address Line 2

CityCounty

PostcodeCountry
Employment start date

MonthDayYear
Employment end date*

MonthDayYear
Responsibilities
Reason for leaving
Employment details

CompanySupervisorPhone numberEmailJob title
Company Address

Street Address

Street Address Line 2

CityCounty

PostcodeCountry
Employment start date

MonthDayYear
Employment end date*

MonthDayYear
Responsibilities
Reason for leaving

Education Please use this section to provide information about your previous education including the qualifications/certificates your have gained.
High School/College

School nameStart dateFinish date
Address

Street Address

Street Address Line 2

CityCounty

PostcodeCountry
Subjects and grades
University

School nameStart dateFinish date
Address

Street Address

Street Address Line 2

CityCounty

PostcodeCountry
Subjects and grades
Other

School nameStart dateFinish date
Address

Street Address

Street Address Line 2

CityCounty

PostcodeCountry
Subjects and grades

Refrences Please use this section to provide a list of three professional references.
Referee 1

Full nameRelationshipPhone numberCompany
Address
Referee 2

Full nameRelationshipPhone numberCompany
Address
Referee 3

Full nameRelationshipPhone numberCompany
Address

Criminal record Due to the nature of the posts within THCS, they may be exempt from the Rehabilitation of Offenders Act 1974 (exception Orders1975). If the post applied for requires a Disclosure as indicated on the front page, you should disclose information of all spent and unspentconvictions as well as details of any cautions, reprimands or final warnings, whether in the UK or abroad.
YesNo
YesNo
YesNo
If you have answered YES to any of the questions above, please give further details.
I certify to Total Healthcare Solutions that the information are true and complete to the best of my knowledge, and I consent THCS in processing personal data about me for purposes related to my employment in line with the DATA PROTECTION ACT, 1998. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my refusal or termination of employment.

I agree