REM Application Form

REM Application Form

This for is to be used by all new applicants & returning staff
Please note: we do not keep staff records on file once they have left the company.
Your details
Name

First NameLast Name
DOB

DayMonthYear
2 digit day, 2 digit month, 4 digit yearWhy are we asking for this? Some roles at REM Ltd require you to be over a certain age. For example, driving. This does not influence the deciding factors.
Address

Street Address

Street Address Line 2

City / TownCounty

Postal Code
Best contact number
Please enter a valid phone number.Format: 00000000000.
Email
example@example.com
NI NO
Are you an NHS professional returning to practise?

Rehabilitation of Offenders Act
In order to protect certain vulnerable groups within society, there are a number of posts and professions that are exempt from the provisions of the Rehabilitation Offenders Act 1974. These include posts where, in the normal course of their duties, successful applicants will have access to persons in receipt of health services.

If the post you have applied for falls within the above category, it will be exempt from the provisions of the Rehabilitations Act by virtue of the Rehabilitations Act (Exceptions Order) 1975.

Applicants are therefore not entitled to withhold any information about convictions which for other purposes are "spent" under the provisions of the Act and in the event of employment/worker agreement, any failure to disclose such information will result in dismissal or disciplinary action by the company.

Any information given will be confidential and will be considered only in relation to posts to which the order applies.
Have you at any time received, or had pending, a court conviction?
Please give details
DBS
Do you hold a current, valid Enhanced DBS?
Is this on the DBS update service?
What group/s of individuals does this cover you to work with?
If your application is successful to the interview stage and you require a REM Ltd enhanced DBS check. Please bring the following documents with you to your interview…

"The applicant must be able to physically show: one document from Group 1, below two further documents from either Group 1, or Group 2a, or 2b, below. At least one of the documents must show the applicant’s current address."

Useful information can be found HERE for ID documents required.
Please select the relevant option below

Education & Qualifications

Please list Chronologically, starting with your most recent.
Name of school/college/University
Date Obtained

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
Qualification gained
Grade
- Name of school/college/University
- Date Obtained
  
  DayMonthYear
  2 digit day, 2 digit month, 4 digit yearDate
- Qualification gained
- Grade
- Name of school/college/University
- Date Obtained
  
  DayMonthYear
  2 digit day, 2 digit month, 4 digit yearDate
- Qualification gained
- Grade
- Name of school/college/University
- Date Obtained
  
  DayMonthYear
  2 digit day, 2 digit month, 4 digit yearDate
- Qualification gained
- Grade
- Name of school/college/University
- Date Obtained
  
  DayMonthYear
  2 digit day, 2 digit month, 4 digit yearDate
- Qualification gained
- Grade

Employment History

Please list Chronologically, starting with your most recent or last employer
Name and address of employer
Date from

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
Date to

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
Job title
UTRN Unique Tax Reference Number Where to find it:
Check HMRC Correspondence Your UTR is printed near the top right corner of most correspondence from HMRC. Look through your files for:Welcome Letter: Your initial SA250 "Welcome to Self Assessment" letter.Tax Returns: Any copy of a previous Self Assessment tax return.Payment Reminders: Annual notices to file a tax return, statements of account, or tax bills
Roles and responsibilities
Reason for leaving
- Name and address of employer
- Date from
  
  DayMonthYear
  2 digit day, 2 digit month, 4 digit yearDate
- Date to
  
  DayMonthYear
  2 digit day, 2 digit month, 4 digit yearDate
- Job title
- Roles and responsibilities
- Reason for leaving
- Name and address of employer
- Date from
  
  DayMonthYear
  2 digit day, 2 digit month, 4 digit yearDate
- Date to
  
  DayMonthYear
  2 digit day, 2 digit month, 4 digit yearDate
- Job title
- Roles and responsibilities
- Reason for leaving

Professional Body / Organisation Memberships
If you are applying for a post that requires professional registration you are required to provide the following information...
Name of Professional Body/Organisation membership
Registration number
Are you currently the subject of a fitness to practise investigation or proceedings by a licensing or regulatory body in the UK or another country?
Have you been removed from the register or have conditions been made on your registration a fitness to practise committee or regulatory body in the UK or another country?

References
Please give the details of the people who have agreed to provide a reference. For all positions, you must provide two references. If you are or have been employed, this should be your most recent employer. These may include your line manager or someone in a position of responsibility who can comment on your work experience, competence, personal qualities, and suitability for the post. If you are a student, please provide the details of your teacher, college or university tutor.

Your second reference should be a personal reference, somebody who can comment on your personal qualities and suitability for the post. All references will be approved prior to the interview unless stated otherwise.
- Referee 1
  
  Professional
- Name
  
  First NameLast Name
- Job title
- Address
  
  Street Address
  
  Street Address Line 2
  
  CityCounty
  
  Postal code
- Phone Number
  Please enter a valid phone number.Format: 00000000000.
- Email
  example@example.com
- Relationship
- Can the referee be contacted before interview?
- Referee 2
  
  Personal
- Name
  
  First NameLast Name
- Job title
- Address
  
  Street Address
  
  Street Address Line 2
  
  CityCounty
  
  Postal code
- Phone Number
  Please enter a valid phone number.Format: 00000000000.
- Email
  example@example.com
- Relationship
- Can the referee be contacted before interview?

Supporting Information
In this section please give your reasons for applying and any other additional information which shows how you match the specifications for the role you are applying for.

This can include relevant skills, knowledge, experience, voluntary activities and training, etc. If relevant to the role you are applying for, this should include details of research experience, publications, poster presentations, clinical care (knowledge and skills) clinical audits.
Supporting information (Please use the additional sheet if needed...)
- Supporting information (additional sheet)

Supporting Documents
Please upload any supporting documents which may assist your application.

Such as...

Your CV*

Certificates (FREC, trainer qualifications, ILS, degrees, BLS...)

CPD certificates of attendance (completed within the last six months)

If you do not hold the required certificates to upload, you will need to complete an e-course and upload the certificate upon completion. All certificates must hold a minimum of five months' validity.

* = Required.
Upload Main Qualification

Cancelof
DBS Enhanced (Must have 12 months validity)

Cancelof
Driving Licence Front & Rear

Cancelof
BLS ( must have five months validity)

Cancelof
ILS ( must have five months validity)

Cancelof
GDPR Certificate (Must have minimum of 5 months validity)

Cancelof
- Safeguarding Children Lev 2 (Must have minimum of 5 months validity)
  
  Cancelof
- Safeguarding Adults Lev 2 (Must have minimum of 5 months validity)
  
  Cancelof
- Information Governance (Must have minimum of 5 months validity)
  
  Cancelof
- Martyns Law certificate
  
  Cancelof
- Diversity & Inclusion Certificate(Must have minimum of 5 months validity)
  
  Cancelof
- Prevent (Must have minimum of 5 months validity)
  
  Cancelof

Log of Medical Events attended in the past 12 months. Date/Times/Length/Event Name/Contact for verification(compulsory for FREC Cert holders)

Cancelof
Medical Gasses Certificate ( not covered in main qualification training)

Cancelof
Over the Counter Medications Certificate

Cancelof
Infection Prevention Control Certificate

Cancelof

Declaration
I,FULL NAME*
Can confirm that...
Signature
Should be Empty:

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Morning
Afternoon
Evening
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REM Application Form

Your details

Driving

Rehabilitation of Offenders Act

DBS

Equal Opportunities Monitoring

We are also monitoring religion/belief in applications

Disability Discrimination Act 1995

Preferred Hours

Education & Qualifications

Employment History

Professional Body / Organisation Memberships

References

Referee 1

Referee 2

Supporting Information

Supporting Documents

Declaration