Registration nformation

ALL SECTIONS SHOULD BE COMPLETED IN FULL, ANY SECTION NOT COMPLETED PLEASE SPECIFY REASON
Title

MrMrsOther
Name

First NameCurrent Surname
Previous Surname
Date used until

MonthDayYear
Date
Previous Surname
Date used until

MonthDayYear
Date
Gender
Date of Birth: (DD/MM/YYYY)

MonthDayYear
Date
City of birth
Country of Birth
Nationality
National Insurance No
Landline No
Mobile No
Email
example@example.com
Emergency contact details Next of Kin
Current Address
Postcode
When did you move to this address
Please provide previous address history for the purposes of the DBS check, it MUST cover the last 5 years

Healthcare Training (Must have Moving and Handling practical / Health and Safety / Safeguarding) Only applies to Healthcare related vacancies.
Provider
Certificate Name
Completed on
Expires on

Healthcare Training (Must have Moving and Handling practical / Health and Safety / Safeguarding) Only applies to Healthcare related vacancies.
Provider
Certificate Name
Completed on
Expires on

Healthcare Training (Must have Moving and Handling practical / Health and Safety / Safeguarding) Only applies to Healthcare related vacancies.
Provider
Certificate Name
Completed on
Expires on

Healthcare Training (Must have Moving and Handling practical / Health and Safety / Safeguarding) Only applies to Healthcare related vacancies.
Provider
Certificate Name
Completed on
Expires on

Healthcare Training (Must have Moving and Handling practical / Health and Safety / Safeguarding) Only applies to Healthcare related vacancies.
Provider
Certificate Name
Completed on
Expires on

WTD
WTD 1998 says that you the Temporary Worker do not have to work on an Assignment with the Client in excess of the 48- hour Working Week unless you agree in writing that this limit should not apply.

Yes, I consent to opting out of Maximum HoursNo, I do not want to work more than 48 Hours

DBS
Have you ever been barred from working with adults or children?

YESNO
If YES, explain:
Have you ever been convicted of a criminal offence, cautioned, sentenced, reprimandted or given a final warning by the police?

YESNO
If YES, explain:

Child Declaration Form (Only applies to candidates registering for education related jobs, if you are applying for Healthcare position only, you do not need to complete this form)
Name
In October 2014, the Department for Education (DfE) issued an update to its Statutory Guidance “Keeping
Children Safe”.
This update requires schools which provide care for pupils under the age of 8, to ensure that staff and
volunteers working in these settings are not disqualified from doing so under the Childcare (Disqualification)
Regulations 2009.
A person may be disqualified through:
• Having certain orders or other restrictions placed upon them
• Having committed certain offences
• Living in the same household as someone who is disqualified by virtue of 1 or 2 above (this is
known as disqualification by association)
You are required therefore to sign the declaration below confirming that you are not disqualified under
those Regulations from working in this school.
If you fail to complete and return this form, this will be regarded as a disciplinary matter for staff, which may
result in dismissal and in the case of volunteers, will mean that you can no longer work at the school.
A disqualified person is not permitted to continue to work in a setting providing care for children under the age
of 8, unless they apply for and are granted a waiver from OFSTED
Signature

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