Application for Employment

Application for Employment

Please complete this form as fully and as accurately as possible. If you have any problems with the form, or need to forward additional supporting information, please drop us an email at recruitment@codebluemedical.co.uk.
Codeblue Medical is a trading name of ACLS Training Services Limited.

You will need to send through:

- Copy/Proof of your highest clinical qualification

- Copy/Proof of your Emergency Driving qualification (if Appropriate)

- Copy of both sides of your Photocard Driving License

- Copy of your most recent DBS Certificate (Enhanced Level) and Update Service Information. If you do not have a DBS less than 3 months old or on the update service, get in touch, we can arrange this for you at your cost if you are to be self employed.

- Proof of Right to Work in the UK (e.g. Proof of NI Number, or Work Visa)

- Proof of UTR or Registered Company Number (Unique Tax Reference - If to be Self Employed)
Position Applied For:*
If responding to a specific vacancy, please also put the vacancy code here.
Which type of contract/employment are you looking for?*

Bank / Zero Hours - Self Employed (Please note, you will need to provide a UTR (Unique Tax Reference) issued by HMRC or details of a Registered Company Number to undertake this type of employment.Other - Please Confirm Below
If (Other) Above, Please Specify Here.
Have you ever applied for employment or worked for Codeblue Medical before?*

YesNo
If Yes, to the question above, please state where, when and in what capacity:
Personal Information:
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*

Area CodePhone Number
Email*
example@example.com
Do you hold "The right to work in the UK"?*

YesNo
National Insurance (NI) Number:*
Have you held a FULL UK (Manual) Driving License for more than 2 years?*

YesNo
Personal Statement
Tell us a little about yourself... What makes you tick?*
Who are you, What do you like/dislike, current abilities and interests, aspirations for the future etc.
Please tell us why you've applied for this role and why you think you're suited to it:*
General Education and Training
Please include details of your current qualifications, including any full/part time courses include apprenticeships, correspondence courses and vocational qualifications:
Please include: "Subject Studied/Course Title", "Qualification Achieved", "Grade Attained".
Do you hold any of the following qualifications?

Teaching (Any Level)Assessing (Any Level)IQA (Any Level)Mentorship (Any Level)
If Yes, to the Above, Please give details here:
Driving:
Do you hold a full EU/UK Driving License?*

YesNo
Do you hold a C1 Category on your Driving License?*

YesNo
Do you have any penalty points or endorsements?*

YesNo
If Yes, Please provide details:
Do you give permission for Codeblue Medical to use information provided by you to carryout UK Driver Checks on your behalf?*

YesNo
Do you hold an Emergency Driving Qualification?*

YesNo
If Yes, Please provide details:
Professional Registration:
Are you registered with any of the following professional bodies?*

HCPCNMCGMCOtherI'm Not a Registered Clinician...
Please give details below including your registration numbers, date gained and expiry date.
Are you currently employed by the NHS or another Private Provider?*

YesNo
If Yes to the above, please give details:
Convictions and Legal Proceedings

Please read carefully and select the correct options.
Ex-offenders will be considered for employment on their merit. Under the rehabilitation of offenders act 1974, you are not required to enter details of any offences which are spent under the terms of the act. However, if you are applying for a position that has regulated activities, you will be subject to an enhanced DBS check. You must give details of any convictions, cautions, reprimands and final warnings that are not protected under the DBS filtering rules as defined by the Rehabilitation of offenders act 1974 (exceptions) order 1975 as amended in 2013. The amendments to the Exceptions Order 1975 (2013) provide that certain spent convisions and cautions are 'protected' and are not subject to disclosure to employers and cannot be taken into account.

You hereby agree to a full disclosure to the company and/or any trust as required. The company will carry out background checks either directlyor via an agency into the suitability where you may be required to work with vulnerable groups (such as children, the elderly or inform). Codeblue Medical from time to time may register an interest with the DBS online for ligitimate reasons and may carry out an online check on your status and receive updates seeking to understand whether an employees status changes. You consent to this disclosure.

Where it is found that an individual has intentionally provided inaccurate information or withheld relevant information to their position, this may disqualify them from appointment.

If you are unsure what information may be disclosed on your DBS check, please visit filtering rules for criminal record checks on www.gov.uk.
Have you ever been Convicted or Cautioned for a criminal or motoring offence?*

I have NOT been cautioned or convicted for a criminal or motoring offence.I have been cautioned/convicted for a motoring offence and have given details below.I have been cautioned/convicted for a criminal offence and have given details below.
Please give further details:
I already have a DBS Check at Enhanced Level that is registered with the "Update Service"*

YesNo
If You've answered "Yes" Above, please give details including Certificate Number and Date of Birth to enable us to re-check your existing DBS.
Employment Details

Please include details of present or most recent employment and all employment over the last 2 years. Include any periods of voluntary work, caring, homemaking or unemployment in these sections, with dates. References will be sought as appropriate. Please also include any employment within a CQC Registered Service within the past 5 years.
Current or Most Recent Employer's Name:*
Current or Most Recent Employer's Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Current or Most Recent Employer's Email Address:*
example@example.com
Current or Most Recent Employer's Phone Number:*

Area CodePhone Number
Job/Role Title and Responsibilities*
Employment Start Date (Most Recent Employer):*

MonthDayYear
Date
Employment End Date (Most Recent Employer):

MonthDayYear
If you are still employed, please leave blank.

Previous Employment Details:*

	Previous Employer 1	Previous Employer 2	Previous Employer 3	Previous Employer 4
Employer Name
Employer Address
Employer Email
Employer Tel
Start Date
End Date
Role Title
Responsibilities

Additional Notes for Employment History:
Referees
Referee 1 Name:*

First NameLast Name
Referee 1 Email Address:*
example@example.com
Referee 1 Telephone Number

Area CodePhone Number
How does Referee 1 know you, and for how long?
Referee 2 Name:*

First NameLast Name
Referee 2 Email Address:*
example@example.com
Referee 2 Telephone Number

Area CodePhone Number
How does Referee 2 know you, and for how long?
Supporting Information:

Here's your opportunity to upload and attach to your application, any information which would support your application, such as certificates, CV, Personal Statement, Existing DBS (If on Update Service) and any other relevant information. Further information can also be emailed to info@codebluemedical.co.uk.
Please Write any further supporting information here (and use the File Upload below to upload any supporting documents).
File Upload

Cancelof
GDPR Consent

Please read carefully.
Codeblue Medical takes your privacy seriously and will use your personal infromation for the necessary administration of yourself and to ensure your ongoing compliance with company policies.

Additionally, Codeblue Medical will use your information to demonstrate compliance with:
- Contractual requirements with NHS and Local Authority Clients
- Contractual requirements with Private Clients (Specific List can be supplied if required/requested)
- Organisations such as the Care Quality Commission (CQC), Information Commissioners Office (ICO), HM Revenue and Customs (HMRC) or any other government body with a legitimate legal requirement to do so.
- Legal Consultancy.
- Your chosen union representative/body.
Please confirm that you give consent for Codeblue Medical / ACLS Training Services Ltd to communicate your data as defined above in the following manner:*

MailEmailTelephoneSMSAutomated Call
Why are we doing this?

Codeblue Medical is doing this because of legislation which requires that you are given genuine control of YOUR data. This requires that you give your implicit, informed consent and that you have the absolute right to know what information is held about you and to have that information corrected or deleted if it is wrong. That being said, Codeblue Medical is required to maintain certain records to meet legal requirements You may withdraw your consent where the infromation is held without a "Lawful basis for processing" at any time. Codeblue Medical will retrain a record of your consent and will regularly review your consent to check that the relationship, the processing and the purposes have not changed. Codeblue Medical will only retain your information as long as it has a legal basis to do so.
If you wish to consent, please sign below:*

Clear
Name*

First NameLast Name
Equality and Diversity Monitoring:

We need your help and co-operation to enable us to do this, but filling in this part of the form is voluntary.
Codeblue Medical wants to meet the aims and commitments sent out in it's equality policy. This includes not discriminating under the Equality Act 2010, and building an accurate picture of the make-up of the workforce in encouraging equality and diversity.
Gender:

MaleFemaleTransitioningNon BinaryPrefer Not to SayEnter Your Own
Are you Married, or in a Civil Partnership?

YesNo
Age:

Under 1818-2425-2930-4445-6465 and Over
What do you consider to be your Ethnicity?
Ethnic Origin is not about nationality, place of birth, or citizenship, it is about the group to which you perceive you belong..
Do you consider yourself to have a disability or health condition?

YesNoPrefer Not To Say
If yes above, What is the effect of your disability or health condition on your ability to give your best at work? Please write below:
The information in this form is for monitoring purposes only. If you believe you need a "Reasonable Adjustment", then please discuss this with the Codeblue Team.
What is your religion o belief:

No Religion or BeliefBuddhisChristianHinduJewishMuslimSikhPrefer Not to SayOther
Do you have any caring responsibilities?

NonePrimary Carer of a Child/Children (Under 18)Primary Carer of a Disabled Child/ChildrenPrimary Carer of a Disabled Adult (Over 18)Primary Carer of Older PersonSecondary Carer (Another Person Carries out the main caring role)
Declaration
I declare that the information provided on this application form is, to my knowledge, true and accurate. I understand that if it is subsequently discovered that any statement is false or misleading, I may be discharged from employment with Codeblue Medical. With the exception of offenses, which are "spent" under the terms of the Rehabilitation of offenders act 1974, I have included details of criminal or court-martial convictions, including driving convictions.

I understand that it will be necessary to undergo a disclosure and barring service check, which will ask exempted questions under the rehabilitation act 1974 and will show offences that are "spent" under the act.

I agree to a driving assessment, eyesight, and drugs test if required, to assess my fitness to carry out essential driving functions within the role and acknowledge that if i fail any of these tests, my employment may be terminated.

I am legally entitled to take paid employment in the United Kingdom, I consent to Codeblue Medical seeking references from my previous employers.

Electronic Data relating to employment applications is stored for a maximum of 6 months. If you wish your individual data to stop being processed before that, please write to the HR Department and make that request.
Please mark to confirm that you have read and understood the above statement*

Confirmed
THANK YOU FOR COMPLETEING THIS APPLICATION, YOU ARE ASSURED THAT IT WILL BE TREATED IN THE STRICTEST CONFIDENCE.

IF YOU SUCCESSFULLY PASS THIS STAGE OF OUR RECRUITMENT PROCESS, A MEMBER OF OUR TEAM WILL BE IN TOUCH TO PROGRESS YOUR APPLICATION TO THE NEXT STATE.

Whilst we do endeavour to respond to all applicants, if you do not hear from us within 14 days of submitting your application, please assume you have been unsuccessful on this occasion. Unsuccessful applicants will become eligible to re-apply for a position within Codeblue Medical after a period of 6 months.
Should be Empty:

Application for Employment

Personal Information:

Personal Statement

General Education and Training

Driving:

Professional Registration:

Convictions and Legal Proceedings

Employment Details

Referees

Supporting Information:

GDPR Consent

Why are we doing this?

Equality and Diversity Monitoring:

Declaration