RMS Application

Date of application

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Genral Data Protection Regulation Statement

The personal information (data) collected on this form, and on the attachments, (which includes the collection of sensitive personal data) is collected for the purposes of recruitment, personnel administration (for new employees) and monitoring. Unless you direct otherwise (for example in a situation where you would like this application kept on file for future vacancies) the Application Forms (and attachments) of unsuccessful applicants will be destroyed after 6 months. It is the policy of the Company to protect, and keep secure, all personal data collected. All personal data is processed for the purposes of recruitment, and, in the case of successful Applicants, for the satisfactory administration of their employment, and for no other purpose.

Equality of Opportunity Statement

The Company’s Equal Opportunities Policy covers all employees, or potential employees, and embraces the principle that all people shall be treated equally, regardless of their age, gender, ethnic origin, nationality, colour, religion, marital status, sexual orientation, religion or belief, disability, or offending background.

Further uploads at the bottom of the form to support your application, you may wish to add;

- CV - Certificates - Letters/statements

- DBS - Transcripts - Visas

Position applying for*

Name*

PrefixFirst NameMiddle NameLast Name

Date Of Birth*

DayMonthYear

Gender:

If requiring a DBS RMS will require 5 years of addresses with no breaks, please enter these if required

Address*

Street Address

Street Address Line 2

CityCounty

Postal Code

Other address if requiring a DBS for a period of 5 years please put dates (only if applicable)

Skill grade:*

What you currently practice as

Registration details if applicable:

Contact Number:*

Area CodePhone Number

National Insurance Number:*

Next of kin details and contact:*

Picture of applicant required:

Clear face picture

Email address (copy of this will be sent)

example@example.com

Disclosure and Barring Service (DBS) update service number:

If you are not on the update service then you will be required to provide further information regarding this application.

you will need to include the following information to apply or upload identifaction:

5 Years of address history with no break
Passport (upload at the bottom of the form)
Council tax/P45/wage slip/Utlility bill with current address within the final 3 months (mobile bills will not be accepted

Any criminal convictions or currently under investigation?*

If yes or under investigation please read the rehabilitation act at the bottom.

Driving license number:

To allow staff to drive RMS Ambulance Limited vehicles a drivers licence check will need to be done.

Please follow the instructions to allow a limited time access to validate licence details.

follow the link: https://www.gov.uk/view-driving-licence

Before you start
You’ll need:

your driving licence number
your National Insurance number - find your National Insurance number if you’ve lost it
the postcode on your driving licence

Follow the instructions and and then place the code below this will allow access for 21 days for code holders.

DVLA access code;

This will last for 21 days

Additional classes on license::

C, C1

Additional qualifications for driving:

CERAD, IHCD

Driving offences, list offences and awards and date issued.

RMS will check driving licence details against DVLA and will require permission for access.

Driving offences:

If yes to driving offences please state here:

SP30 = 3 points

Drivers licence (front):

Drivers licence (back):

Education:*

School, collage, university

Employment history:*

From leaving education to date (any gaps please explain)

Qualifications relatable to the position applied for:

copy of certificates to be uploaded at the bottom of the form

Referees

You must provide references from your two most recent employers. All will be contacted, therefore please inform the referees of the fact that you

have used their name. If you are unable to provide the required references, please discuss the matter with us.

Current or most recent Employer

1. Reference contact details (position, preferred contact details) :*

Someone known more than 2 years in a professional capacity

2. Reference contact details (position, preferred contact details) :*

Someone known more than 2 years in a professional capacity

Medical questionnaire (tick in the box if applies)

	Yes I suffer/have from:	Further information required, i.e. management/restrictions
Asthma, Hay fever or other breathing problems?
Eczema, dermatitis or other skin problems?
Blackouts, fits, epilepsy, fainting attacks or dizziness?
Mental or nervous disorder or depression?
Diabetes?
Back/joint problems?
Eye or ear problems?
Addiction to alcohol or drugs?
Hernia or rupture?
Had an operation?
Been seriously injured?
Suffered a broken/fractured back, pelvis, arm or leg?
Been registered disabled if so what adjustment are required to work?
Absences from work in the last 12 months, except holidays (if so please state)
Any illnesses/accidents/injuries in the last 2 years (please state)?

Medical (if further information is required enter here)

Capacity to Work In The UK

Under Section 8 of the Asylum and Immigration Act 1996 it is a criminal offence to employ a person aged 16 or over who is subject to immigration control unless:

-That person has current and valid permission to be in the United Kingdom and that permission does not prevent him or her from taking the job in question; or

- The person comes into a category specified by the Home Secretary where such employment is allowed

Any employment offered will be subject to the successful applicant producing appropriate evidence that the Asylum and Immigration Act is not being contravened.

Are you eligible to work in the UK? *

Required

Are there any restrictions to your residence in the UK which might affect your right to take up employment in the UK?

Required

If you are successful in the application, would you require a work permit prior to taking upemployment?

Required

Rehabilitation of Offenders Act

As a general rule, no-one needs answer questions about spent convictions. However, this general rule does not apply to specified professions, employments and occupations. By virtue of the Rehabilitation of Offenders Act 1974 (Exceptions) (Amendment) Orders, the exemption rule does not apply to:

a) any employment or other work which is concerned with the provision of health services and which is of such a kind as to enable the holder of that employment or the person engaged in that work to have access to persons in receipt of such services in the course of his normal duties, or

b) any employment or other work which is concerned with the provision of care services to vulnerable adults and which is of such a kind as to enable the holder of that employment or the person engaged in that work to have access to vulnerable adults in receipt of such services in the course of his normal duties

One or both of the above apply to work with RMS Ambulance Limited and covers all occupations.

You are therefore requested to provide details of all convictions, including those which would otherwise be considered as “spent”. All employment applications will be considered carefully, and the disclosure of a conviction does not imply that this employment application will be rejected.

Records will be checked via the Disclosure and Baring Services procedures

History on convictions are:

Required

If answered yes or spent in the convictions further information is required to the nature and the outcome.

This will not exclude you from working with RMS but a risk assessment/conditions may be required if offered a poistion with RMS.

Personnel Declration

I declare that to the best of my knowledge the above information, and that submitted in any accompanying documents, is correct, and

. I give permission for any enquiries that need to be made to confirm such matters as qualifications. Experience and dates of employment and for the release by other people or organisations of such information as may be necessary for that purpose.

· I give permission for the processing of the personal data contained in this form for employment purposes.

· I understand that any false or misleading information could result in my application not been progressed.

The information that you have provided in this form (and any other personal information we may receive from you or your referees) is confidential and will be handled in line with the Genral Date Protection Regulation 2018 (GDPR). Your information will be used to make a decision about whether or not you are suitable for the position that you have applied for.

Prior to such a decision being made, your information will not be used for any purpose other than monitoring our own recruitment processes. Where your information is used for statistical analysis, it will be anonymised. If your application is not successful, we will retain only basic information about you; all other information will be destroyed. If your application is successful, the personal information you have provided will be used for legitimate purposes in relation to your on-going employment; your contract of employment, which you will be asked to sign before starting work, will include further detail on how your information may be used. If any of the referees that you have named on this form are based outside of the European Economic Area, you consent to our pursuing references from those named, even if this means sending basic personal information about you (name and date of birth) outside the EEA.By signing this form, you confirm that you understand this privacy notice and you consent to our processing your personal information for the purposes described or as otherwise permitted or required by law in line with our registration with the Information Commissioner.

I also understand that if offered a poistion i will have to complete an induction process and as a freelance contractor I am respobslble for my own personnel finicail arrangments with the HMRC.

If being offered a poition witin RMS Ambulance Limited this will constute as a contract and will abide by all its policies and proceedures, it will be the responsibility of the employeed to keep upto date with changing policies and to inform managment of any changes.

Signed (name as stated on the application):*

Certificates:*

Certificates:

Other upload:

Visa/statements/CV/further relevant certificates/ DBS/ Passport

Other upload:

Visa/statements/CV/further relevant certificates/ DBS

Other upload:

Visa/statements/CV/further relevant certificates

Other upload:

Visa/statements/further relevant certificates

Other upload:

Visa/statements/further relevant certificates

Email

example@example.com