Application Form

Job Application Form

Please Fill Out the Form Below to Submit Your Job Application!
Name*

PrefixFirst NameMiddle NameLast Name
Date of Birth*

DayMonthYear
Address*

Street Address

Street Address Line 2

CityCounty

Postcode
Date Moved to this address*

DayMonthYear
Date
Previous Address within 5 years

Street Address

Street Address Line 2

CityCounty

Postcode
E-mail*
example@example.com
Phone*
Include Country Code if abroad
Position Applied for*
Part Time/ Full Time Position*
Earliest Possible Start Date

DayMonthYear
Date
Do you have Right to work in the UK*

YesNo
National Insurance Number
WORK STATUS
Employer*
Current/Most Recent
Your Job title*
Summary of Duties*
Phone*
Include Country Code if Abroad
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityCounty

Postcode
Date Started*

DayMonthYear
Date
Date Left/ Leaving (if applicable)

DayMonthYear
Date
Previous Employer
Employer*
Your Job title*
Work Address*
Email*
example@example.com
Phone*
Date Started*

DayMonthYear
Date
Date Left

DayMonthYear
Date
Any gaps in employment, state reasons and period
Example Childcare, Career Break
QUALIFICATIONS INCLUDING FURTHER EDUCATION
Training Courses Relevant to Role Applied for*
PROFESSIONAL REGISTRATION
Registered Board
Registration Number
REFERENCES

Professional Reference
Name of Referee*
Company Name*
Job title*
Address*
Include Postcode
Phone*
Include Country Code if Abroad
Email*
example@example.com
Character Reference
Name of Referee*
Relationship*
Time You Have Known Each Other*
Address*
Include Postcode
Phone*
Include Country Code if Abroad
Email*
example@example.com
PERSONAL HEALTH BACKGROUND
Are you currently receiving treatment for any medical condition*

YESNO
If you answered 'Yes' , please state
Are you aware of any physical, mental or health reasons that would preclude or limit you from working with a Healthcare Agency with Vulnerable Adults*

YESNO
If you answered 'Yes' , please state
Can you confirm that you are mentally and physically fit to do the job that you have applied for*

YESNO
If you answered 'No' , please state reason
DISCLOSURES
Have you ever been cautioned, reprimanded, investigated or convicted of a criminal offence*

YESNO
If 'Yes' , please provide details
Are you currently under any investigation from the Police or Safeguarding Adult's Team or waiting to go to Court*

YESNO
If 'Yes' , please provide details
Please note that, due to the nature of the work for which you are applying, this post is exempt from the provisions of the Rehabilitation of Offenders Act 1974 (exemptions) order 1975.

Infinite24 Healthcare aims to promote equality of opportunity for all, with the right mix of talent, skills and potential. We consider applications from diverse candidates. Criminal records will be considered and taken into account for recruitment purposes only. Due to the nature of the work , you will be asked to disclose all convictions which are spent under the Rehabilitation of Offenders Act 1974. Having an unspent conviction will not necessarily bar you from employment. This will depend on the circumstances and background to your offence(s).

As Infinite24 Healthcare meets the requirements in respect of exempted questiones under Rehabilitation of Offenders Act 1974, all applicants who are offered employment will be subject to a criminal record check from the PVG Scheme before a decision is made on suitability for employment and the appointment is confirmed. This PVG check will verify and include details of cautions, reprimands and final warnings, as well as convictions.

*** A copy of our written policies is available upon request***
DECLARATION
I confirm that the information l have provided in support of this application is complete and true, and l understand that knowingly making a false statement could be a criminal offence.
Signature*

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Date*

DayMonthYear
Date
I consent to Infinite24 Healthcare checking the details l have provided against the various data sources in order to verify my identity and process the application. These details may be recorded and used to assist other organisations for identity verification purposes such as the PVG and also Regulatory Bodies like NMC or SSSC.
Signature*

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Date*

DayMonthYear
Date
Infinite24 Healthcare retains the right to hold this application and any other data required to process this application and keep for as long as necessary in line with the Data Protection Act.
Should be Empty:

Job Application Form

WORK STATUS

Previous Employer

QUALIFICATIONS INCLUDING FURTHER EDUCATION

PROFESSIONAL REGISTRATION

REFERENCES

Character Reference

PERSONAL HEALTH BACKGROUND

DISCLOSURES

DECLARATION