• Right to work (Biometric Resident Permit, Passport, Visa, Others)
• Proof of identity - passport, driving license, utility bill.
• Recent Enhanced DBS. (Or Fee if applicable at £80)
• References - 2 professional clinical are required. Please provide details of previous employers, including all contact details.
• 2 X recent passport pictures.
• 2 X proofs of address (dated within the last 3 months) such as Utility Bill, Bank Statement, Council Tax Bill, or Driving License
• A recently updated CV/ resume.
• Care Certificate (minimum) if not, training will be provided.
• Other Relevant certificates that you have attained.
• Details of your immunization history.
• Proof of National Insurance number, i.e., N.I card/P45/P60/HMRC Letter (Any one of these).
• A copy of certificate of incorporation and articles of memorandum (Limited company only)
• Bank Account
• NMC statement of entry- nurses only
• Professional Indemnity- nurses only

We make it our mission to find the right roles that match your skills, so you can find the job that will transform your career. This ensures we don't put you forward for anything that wouldn't be right for you. That's why we're the world's leading recruiting experts in qualified, professional, and skilled work. To help us get the ball rolling, you'll need to provide us with evidence of your identity, eligibility to work in the UK (both legal requirements), along with relevant qualifications, career history and references. Where appropriate, a criminal record check and security clearance will be needed.

All information is treated in the strictest confidence, processed, and held in accordance with relevant Data Protection legislation. Please complete this form in full using BLOCK CAPITALS.

We will only accept a fully completed application form.

The following information will be treated in the strictest confidence.

(Please complete this section in BLOCK CAPITALS)

Endorsements

If YES, please give further details including dates

If offered employment, we are required to check your up to date DBS status before you are permitted to start work.

UK legislation requires all candidates to provide appropriate evidence.

If YES, what type of visa do you hold? (All candidates must provide this)

This information helps us to cater for your personal circumstances. Please note that we may use personal date relating to any physical or mental health or condition (e.g; disability) that you provide to us for us to make reasonable adjustments as necessary during the recruitment process in line with our legal obligations.

If YES, please contact your consultant.

In order for us to obtain you work placements that are most appropriate, according to both your own and client requirements please state below your areas of personal expertise and the length of time you have spent working in these areas. Please include your CV if you have one or continue on a separate sheet if necessary.

DECLARATION OF HEALTH / IMMUNISATION REQUIREMENTS.

Please ensure you complete and sign the separate health declaration form enclosed with this application. Team A5 Ltd. employs its own occupational health nurse and agency members are allowed access to this service on a regular basis. Please be assured that all health matters are dealt with on a strictly confidential basis.

IMMUNISATION INFORMATION REQUIREMENTS:

NB: In order to protect yourself and clients, up to date Immunisations are considered a good practice requirement for all agency staff. If you wish to work within NHS Trusts or Private Health Care, immunisations are mandatory requirements. Documentary evidence / photocopies of certificates of immunity will be required as indicated below for your agency file. These should be available from your GP practice or from Occupational Health Services from a previous employer. We are unable to place agency staff into NHS Trusts without evidence of immunisations due to contractual reasons. We strongly advise you to read the requirements below and obtain the necessary immunisations / evidence at your earliest convenience to help your application proceed quickly.

If you require any further information, please contact the office and we will be happy to help.

Declaration

I declare that the information given in this form is complete and accurate. I understand that any false information or deliberate omissions will disqualify me from employment or may render me liable to summary dismissal. I understand these details will be held in confidence by the Company, in compliance with data protection legislation and as set out in the Company's Employee Privacy Notice. I undertake to notify the Company immediately of any changes to the above details.

Given the nature of the job for which I have applied, I understand that any offer of employment will be subject to information on my criminal record being disclosed to the Company by the Disclosure and Barring Service. (Please note that the amendments to the Exceptions Order 1975 (2013) provide that certain spent convictions and cautions are 'protected' and are not subject to disclosure to employers, and cannot be taken into account. Guidance and criteria on the filtering of these cautions and convictions can be found at the Disclosure and Barring Service website.)

I have been given a copy of the Company's Equal Opportunities and Diversity Policy, which includes information relating to the recruitment of ex-offenders.

Please give the names of two people (one of which MUST be your present or most recent employer) whom we may approach for a reference.

Please provide contact details for a character referee. They must be an upstanding member of the community and have known you for 3 years. We may need to obtain this reference to cover any employments gaps.

If you are an overseas applicant who has entered the UK in the last 5 years you must obtain an original police check from your country of origin. All overseas applicants will also require a DBS Check/Disclosure Scotland.

CAR DRIVERS

If you are required to utilise your car for work purposes, you will be required to have business use insurance. We will require a copy of your driving license. Please note that in some instances we will request a copy of your insurance certificate and MOT.

Please read and sign the below:

• I confirm that I do not have any health issues that could impair my driving ability.
• I confirm that my motor insurance, including business class 2, is up to date and that I will renew this annually.
• I confirm that my MOT is current/vehicle is under 3 years old.
• I confirm that my vehicle is maintained in accordance with the manufacturer's recommendations.
• I confirm that | carry out regular minimum safety checks (tyres, lights, wipers & fluids) on my vehicle.

I acknowledge that Team A5 Healthcare will collect, use, store, transfer and otherwise process my personal data, including by providing personal data to third parties and transferring personal data within and outside the European Economic Area. Further details relating to the processing of such personal data are set out in our privacy policy (which may be amended from time to time), available on our website at www.teama5.co.uk

I confirm that the information provided on this form and within my CV, if applicable, is both truthful and accurate. I have omitted no facts that could affect my future employment. I understand that any engagement entered into is subject to documentary evidence of my right to work in the UK and that Team A5 Healthcare will verify any professional qualifications, complete a driving license check (where relevant) and, in the case of temporary assignments, obtain satisfactory references.

I will inform Team A5 Healthcare immediately of any circumstances that may affect my work, such as changes to any requirements for reasonable adjustment to be made to enable me to attend an interview or assessment, or subsequent pending prosecutions or convictions (including motoring offences) which may arise whilst I am participating in the recruitment process for permanent work and/or whilst I am registered for temporary work.

I understand that my registration with Team A5 Healthcare can be terminated at any time following unsatisfactory work reports.

Team A5 Ltd. is committed to a policy of equal opportunities for all work seekers and shall always adhere to sucha policy all times and will review on an on-going basis on all aspects of recruitment to unlawful or undesirable discrimination. We will treat everyone equally irrespective of sex, sexual orientation, marital status, age, disability, race, colour, ethnic or national origin, religion, political beliefs or membership or non-membership of a trade union and we place an obligation upon all staff to respect and act in accordance with the policy.

Team A5 Ltd. shall not discriminate unlawfully when deciding which candidate/temporary worker is submitted for a vacancy or assignment, or in any terms of employment or terms of engagement for temporary workers.

Team A5 Ltd. will ensure that each candidate is assessed only in accordance with the candidates' merits, qualification, and ability to perform the relevant duties required by a particular vacancy.

• I hereby confirm that the information given is true and correct. I consent to my personal data and CV being forwarded to clients. I consent to references being passed on to potential employers.
• I understand that if at any stage I am charges or cautioned after signing this Declaration I must inform Team A5 Healthcare
• I acknowledge that I have been given a copy of the Terms & Conditions of Service issued by Team A5 which is mine to keep and furthermore that I have read those Terms and Conditions and agree to abide by them.
• I am not aware of any condition medical or otherwise which would affect or limit my employment or professional performance other than those declared in my Occupational/Health Declaration Form.
• I acknowledge that Team A5 is authorized to apply for and obtain a Disclosure and Barring Service DBS check, and references from any previous or current employers and educational establishments.
• I agree that the maximum weekly working time specified in Reg 4i, and Regulation 2 of the Working Time Regulations shall not apply to working with Team A5 unless specified.
• I acknowledge that all my personal details will be stored and handled correctly by Team A5 in accordance with the Data Protection Act 1998, however I agree that they may be made available for audit / review by relevant third parties. This will include all references, DBS, and Occupational Health.
• I confirm that I am not currently under investigation or currently suspended by any professional or regulatory bodies or being investigated by any current or previous employer at any point while working for Team A5.
• I confirm that when asked about my working history I will provide accurate information.
• I acknowledge that should I reach a 12-week qualifying period under Agency Workers Regulations I may be asked to send all information and Documentation as evidence of the Qualifying weeks.
• If during the course of a temporary assignment, the Client wishes to employ me direct, I acknowledge that Team A5 Healthcare will be entitled either to charge the client an introduction/transfer fee, or to agree an extension of the hiring period with the Client (after which I may be employed by the client without further charge being applicable to the client.)

I understand that acceptance on to the Team A5 Healthcare register may only be granted after relevant checks are made, satisfactory references are received, and I have attended an interview / Agency Induction.

We are an equal opportunity employer and positively encourage applications from suitably qualified and eligible candidates regardless of sex, race, disability, age, sexual orientation, religion, or belief. To enable us to improve and monitor our employment processes, please complete the sections below and note that this information is confidential and will be used only for the purpose of monitoring.

The Disability Discrimination Act 1995 defines disability as a 'physical or mental impairment, which has a substantial and long-term adverse effect on a person's ability to carry out normal day-to-day activities'.

Team A5 Healthcare is acting as an Employment Agency in respect of permanent recruitment and as an Employment Business in respect of temporary recruitment.