Healthcare Heritage 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 *

MonthDayYear
Date
Address*

Street Address

Street Address Line 2

CityCountry

Post Code
Email*
example@example.com
Phone Number*
Do you have the right to work in the UK?*
NI Number *
Please select role applied for *
Please briefly explain what has made you apply for this role *
Do you hold a UK Driving Licence*
Do you have a car you can use for work?*
Qualifications

Please provide any relevant educational or professional qualifications you hold
Please indicate the highest relevant qualification (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 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

Please give details your employment history in the last 5 years (including self-employment).
CURRENT / MOST RECENT EMPLOYMENT (Please indicate roles & resposibilities)*
PREVIOUS EMPLOYMENT (Please indicate roles and responsibilities)
PLEASE STATE REASON FOR LEAVING THIS ROLE?
PREVIOUS EMPLOYMENT 2 (please indicate most recent role in the over 5 years period)
PLEASE STATE REASON FOR LEAVING THIS ROLE?
EMPLOYMENT GAPS (Please give details of other employment or gaps in employment in the last 5 years in this section (if applicable)
UPLOAD CV*

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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 Declaration

Please indicate the health decleration that is more relevant to you
How do you consider your health*

I am fit and healthy and have no known diseases or infections that can be passed on to those receiving care from meI am currently not fit to work
Type of Contract

Please indicate the contract you are looking for
Please indicate what type of contract you are looking for*

Full-time employmentPart-time employmentBank work (as and when available)Health & social care college studentVoluntary work
Preffered Work Pattern

Please indicate your preffered work pattern.
Please indicate your preffered work pattern.*

I would like to be considered to work weekdays and weekendsI would like to be considered to work weekdays onlyI would like to be considered to work weekends only (e.g student)I am a student and would like to work during summer break only
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 (your last employer if you are / were employed before - if not provide another character referee)*

First NameLast Name
Company's Name & Job Title (i.e Healthcare Heritage Ltd, Manager)
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
REFEREE 2 (character referee)

First NameLast Name
Company's Name & Job Title (i.e Healthcare Heritage Ltd, Manager)
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
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 website
Should be Empty:

Application for Employment

Personal Details

Qualifications

Employment History

Health & Social Care Work Experience

Health Declaration

Type of Contract

Preffered Work Pattern

Availability

References