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 Name
Last Name
Date of birth
*
-
Month
-
Day
Year
Date
Address
*
Street Address
Street Address Line 2
City
Country
Post Code
Email
*
example@example.com
Phone Number
*
Do you have the right to work in the UK?
*
Please Select
Yes
No
NI Number
*
Please select role applied for
*
Please Select
Nurse
Healthcare Assitant
Consultant
Senior Healthcare Assistant
Support Worker
Kitchen Porter
Please briefly explain what has made you apply for this role
*
Do you hold a UK Driving Licence
*
Please Select
Yes
No
Do you have a car you can use for work?
*
Please Select
Yes
No
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 qualifications
I have 'A Level' Health & Social Care qualifications
I hold a Care Certificate or NVQ Health & Social Care qualifications
I am a Registered Nurse
I 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 UK
I have experience of working as a carer in the UK
I have experience working as a nurse in the UK
I have experience working as nurse OUTSIDE OF THE UK
I 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 me
I 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 employment
Part-time employment
Bank work (as and when available)
Health & social care college student
Voluntary 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 weekends
I would like to be considered to work weekdays only
I 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 start
In the next 2 weeks
In the next 6 weeks
In 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 Name
Last Name
Company's Name & Job Title (i.e Healthcare Heritage Ltd, Manager)
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
REFEREE 2 (character referee)
First Name
Last Name
Company's Name & Job Title (i.e Healthcare Heritage Ltd, Manager)
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Are you happy for us to request for your references before your interview?
*
Yes
No
Please inform us how you got to hear about the job you are applying for
*
From an employee of this company
From another person
From a facebook advert
From a flyer at the local store/GP/Pharmacy
From Indeed website
From this company's website
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