• Application Form

  • Position applied for
  • Format: (00000000000).
  • Date of Birth
     - -
  • Do you have a full driving licence?
  • Do you have access to a car for work
  • Do you have any driving endorsements ?

  • Employment History 

  • Employed from to

  • Employed from Employed to .

  • Employed from Employed to .

  • Employed from Employed to .

  • If we require further employment history would you be able to provide it?

  • References

    Please insert your current/most recent employment referee first. We require healthcare references.
  • SKILLS AND EXPERIENCE Please indicate your level of proficiency according to the scale below
    Rows
  • Have you previously undertaken an administration of medication course*
  • Certificate recieved
  • Do you feel confident in administering medication from blister packs?*
  • Do you feel confident in administering medication from original packaging?*
  • How many hours approximately are you looking for each week?
  • Rehabilitation of Offenders Act Due to the nature of this post, you must reply to this question by virtue of the Rehabilitation o Offenders Act 1974, Section 2.4 (exemption order 1975) meaning you must declare any convictions, cautions, reprimands or warnings you have ever received, even those which would normally be considered spent, under the provision of the act and event of employment. Any failure to disclose such convictions could result in dismissal or disciplinary action. All information given will be completely confidential. A criminal record is not necessarily a bar to employment. Have you ever been cautioned or convicted of any offence?*
  • Have you ever been dismissed or suspended from any post because of a safeguarding issue?*
  • Are you currently under any investigation because of your conduct or performance?*
  • Is there any charge against you that remains to be dealt with by any court?*

  • If you are successful at interview and you have answered yes to any of the above, you will be required to complete additional information

  • Are you registered with the SSSC?*
  • Are you subject to any sanctions under a regulatory body? i.e.(SSSC)*
  • Are you a member of the PVG Scheme?*

  • I can confirm that all the information provided here is correct and iI am unaware of any incidents that have occurred that may give rise to or have caused my inability to pass a PVG check. I agree to have a PVG membership or update Scheme record check and understand that any payment made for processing of my PVG is not refundable

  • Equal Opportunities

  • Gold Healthcare operates an equal opportunity policy.As part of this policy we welcome applicants from all parts of the community.It would help us if you would answer these questions which help us monitor how effective our policy is.We treat this information you give us in confidence and we will not use it as part of the recruitment process.Please choose which best describes the ethnic category you belong to:
  • I am
  • Date
     - -
  • Should be Empty: