Application Form
Name
*
First Name
Middle Name
Last Name
Date of Birth
*
-
Day
-
Month
Year
Date
National Insurance Number
UTR Number (if applicable)
Home Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
example@example.com
Mobile Number
*
Please enter a valid phone number.
Photo for ID Card
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Clear image, taken against plain background
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Right To Work
Eligibility to work in The UK - You MUST bring the original documentation, if invited to an interview; as evidence of your entitlement to work in this country. Failure to do so will invalidate your application. Please select one of the following:
*
Please Select
British Passport
Certificate of registration as British Citizen
Passport and ID Card showing right to live & work in the UK
Non-EEA Passport with a relevant and valid visa
UK Home Office issued Biometric residence permit
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Drivers Licence
If you are a Non Driver, you can skip this page.
Copy of Licence
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Licence Number
Licence Catagories
B
C1
C
D1
D
Do you have any endorsement points against your licence? If so, please detail below.
Do you hold a VALID Blue Light Response Qualification?
Yes
No
If yes, what qualifications do you hold.
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CERAD, EFAD, Police Response Ticket
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About you
List 3 Skills & Qualities you have that will make you a great member of our team
Write a brief introduction about yourself; Tell us about you! E.g hobbies, voluntary work/relevant experience
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Qualifications
Clinical Grade
*
Please Select
First Aider (FAW or Equivalent)
Emergency Responder (FREC3 or Equivalent)
Enhanced Responder (FREC4 or Equivalent)
Emergency Care Assistant (FREC4 + CERAD / Trust)
Emergency Medical Technician (IHCD / FREUC5 / AAP)
Nurse (NMC Registered)
Paramedic (HCPC Registered)
Doctor (GMC Registered)
Professional Registration Number (HCP Only)
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Please detail the relevant qualifications you hold.
*
Do you hold an up to date CPD portfolio
*
Please Select
Yes
No
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Employment
Current/Most recent employer? Please include dates, duties expected and notice period if required.
*
Previous employer? Please include details
References - At least 1 professional
Name
Contact
Number
Email
Address
How do you know them?
Mandatory 1 - Professional
Mandatory 2
Optional 3
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Disclose and Barring Service
DBS
Do you have a valid DBS - dated within the past 12 months
*
Please Select
Yes - Update Service
Yes
No
Please upload a copy of your most recent DBS
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Certificate Number
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All Relevant Qualifications & Certificates
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Copy of ID
*
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CV
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REHABILITATION OF OFFENDERS ACT 1974 (EXCEPTIONS) ORDER 1975
In accordance with statutory requirements certain pre-employment checks are conducted for positions involving working with vulnerable groups, specifically children and vulnerable adults. The information obtained from these checks is used to help safeguard these groups. It will not be used to discriminate unfairly against those with convictions which we consider as unrelated to working with vulnerable groups. Having a criminal record will not automatically bar you from employment with us. As the position you are applying for gives you privileged access to vulnerable groups, it is an Exempted Occupation under the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975. This means that you must disclose spent and unspent convictions on this form. This includes any driving offences. Failure to disclose any criminal convictions could lead either to your application being rejected or, if you are appointed, to dismissal if it is subsequently discovered that you have had any criminal convictions. It is a criminal offence to apply for a position working with children if you are excluded from doing so. Failure to complete this form may render your application invalid.
PLEASE LIST ANY CRIMINAL CONVICTIONS BELOW
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Sign Off
My signature confirms that all the information given on this application form is true and complete. I understand that any fabrication or deliberate omissions may disqualify my application or lead to my dismissal. I confirm that I am entitled to work in the United Kingdom and can provide original documentation to confirm this. I understand that my employment is subject to references that are satisfactory to I-Grade Medical & Ambulance Services Limited.
SIGN HERE
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PRINT NAME
*
Thank you for applying to join our team. Due to the significant levels of applications we receive, we are sorry that we are unable to personally respond to all applications. Successful applicants will be contacted within 3-5 working days.
DATE
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Month
Year
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