First Line Application Form

Version Control - Live from 11/2024
First Line Medical

Application Form
Please complete the following information as fully and accurately as possible.

Anything marked with a red asterisk is mandatory.

Before completing the form, please ensure that you can attend a company induction day on February 16th, 2025.

About You

Who are you?
Full Name*

First NameLast Name
Date of Birth*

DayMonthYear
Date
NI Number
Contact Number*
Your Email Address*
example@example.com
Gender*
Your Grade
Address*

Street Address

Street Address Line 2

CityCounty

Postal Code
What is the name of your University?
Do you have a friend at First Line?

NoYes, they are...
Are you eligible to work in the UK?*

YesNo
How do you wish to work?*

PAYE - Wage Slip with DeductionsSub-Contractor - Pay your own tax
Next of Kin

Emergency Contact Details
Their Name*

First NameLast Name
Relationship to you *
Their Phone Number*

Disclosure and Barring Service Checks
Do you have a current Enhanced DBS certificate?*

YesNo
Are you on the DBS Update service?*

YesNo
Are you currently bound over or do you have any current ‘UNSPENT’ convictions, cautions or final warnings that have been issued by a Court or Court-Martial in the United Kingdom or in any other country?*

YesNo
Are you currently bound over, or do you have any convictions, cautions, reprimands, or final warnings which would not be protected (i.e., filtered) as defined by the Exemptions Order 2013 that have been issued by a Court or Court-Martial in the United Kingdom or in any other Country?*

YesNo
If yes, please enter the details here.
Your most recent DBS

Cancelof

HMRC New Starter Checklist
1 - Your Name: {fullName}

2 - Gender: {gender}

3 - Date of Birth: {dateOf}

4 - Address: {address}

5 - National Insurance Number: {niNumber}
Tick one of the following three statements:

This is my first job since last 6 April and I have not been receiving taxable Jobseeker's Allowance, Employment and Support Allowance, taxable Incapacity Benefit, State or Occupational Pension.This is now my only job but since last 6 April I have had another job, or received taxable Jobseeker's Allowance, Employment and Support Allowance, taxable Incapacity Benefit. I do not receive State or Occupational Pension.As well as my new job, I have another job or receive a State of Occupational Pension.
Student Loans

Type 1 Student LoanType 2 Student LoanPostGrad LoanType 4 (Scotland) Student Loan

Employment History

School attendance since age of 11 (Please provide, School or college name and county, as well as dates and grades)
Reference One
Reference One Name*

First NameLast Name
Reference One Email*
example@example.com
Company/Relation to you
Reference Two
Reference Two Name*

First NameLast Name
Reference Two Email*
example@example.com
Company/Relation to you

That's it!
By submitting your application form you are confirming that all the information you have supplied is correct to your knowledge and you are happy for us to automatically email your two references.

Upon submission, our recruitment team will be in touch to arrange the next steps. Thank you for taking the time to complete this application and we wish you the best of luck with your application.
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First Line Medical