• CANDIDATE APPLICATION FORM

    CANDIDATE APPLICATION FORM

    Please complete and return the following items listed below to the following email : info@teama5.co.uk
    • 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.

  • PERSONAL

  • The following information will be treated in the strictest confidence.

    (Please complete this section in BLOCK CAPITALS)

  • Format: 000 000-00000.
  •  -

  • Endorsements

    If YES, please give further details including dates

  • Are you involved in any activity which might limit your availability to work or your working hours e.g., local government?*
  • Are you subject to any restrictions or covenants which might restrict your working activities?*
  • Are you willing to work overtime and weekends if required?*
  • Are you aged over 18?*

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

  • Do you have a DBS certificate?*
  • If yes, are you a current member of the Update Service?*
  • If YES, do you consent to this Update Service check being made by the Company?*
  • Do you have any convictions, cautions, reprimands or final warnings that are not "protected" as defined by the Rehabilitation of Offenders Act 1975 (Exceptions) Order 2013? The Order provides that certain spent convictions and cautions are "protected" and are not subject to disclosure to employers and cannot be taken into account. A copy of the Company's Equal Opportunities Policy and Disclosure and Disclosure Information Policy is available on request.*
  • If offered employment, you will be required to complete a Medical Questionnaire. Are you prepared to undergo a medical examination before employment?*
  • Have you ever worked for this Business before?*
  • Have you applied for employment with this Business before?*
  • Do you need a work permit to take up employment in the UK?*
  • Have you ever been known by another name? (e.g; Maiden name, Christian name, middle, previous name)*

  • ELIGIBILITY TO WORK IN THE UK

  • UK legislation requires all candidates to provide appropriate evidence.

  • Please state by what means you are eligible to work in the UK*
  • If other, do you require a visa permit to work in the UK?*

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

  • Expiry Date*
  • UK Entry Date*

  • HEALTH & SAFETY

  • 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.

  • Do you require any reasonable adjustments to be made/special facilities to be provided to enable you to attend any interview or assessment?*

  • If YES, please contact your consultant.

  • Are you registering for permanent vacancies only?*

  • If seeking temporary work only and/or you are immediately available for work, please provide details of your next of kin

  • If seeking temporary work only and/or you are immediately available for work, please provide details of someone we may contact in case of an emergency, if different from above next of kin information.

  • Contact will only be made strictly in an emergency.

  • Are you applying for Carer/Support Worker role?*

  • You are required to maintain appropriate insurance to cover medical malpractice risks. This insurance may be provided as part of your membership to a relevant organisation or union. Please provide details below along with evidence of your insurance.

  • Own Insurance*
  • Expiry Date*
  • Expiry Date*

  • PROFESSIONAL INDEMNITY - HEALTHCARE PROFESSIONALS ONLY

    PROFESSIONAL REGISTRATION
  • Professional Registration*

  • All professional memberships will be verified relevant professional body.

  • Revalidation Date (if applicable)*
  • Please select your registration body.*

  • MEMBERSHIP OF PROFESSIONAL ORGANIZATION/TRADE UNION

  • It is strongly recommended that all TEAM A5 Ltd. Nursing members have Membership of a professional body and/or trade union. Evidence of membership will be required at interview. Membership details and renewal dates
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  • AREAS OF EXPERTISE

  • 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.

  • Area of work (Please select which apply to you)*
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  • EDUCATION AND PROFESSIONAL TRAININGS

  • Schools (use DD/MM/YYYY format for all dates)*
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  • College/University (use DD/MM/YYYY format for all dates)*
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  • Further Formal Trainings (use DD/MM/YYYY format for all dates)*
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  • Job related training courses (use DD/MM/YYYY format for all dates) *
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  • EMPLOYMENT DETAILS

    Please give details of your past employment, including your present or last employer, stating the most recent in the last 6 years.
  • Date started
  • Date left
  • Date started
  • Date left
  • Date started
  • Date left
  • Date started
  • Date left
  • Are you registered with other nursing agencies?*

  • PRESENT OR LAST EMPLOYER

  • Are you currently employed?*
  •  -
  • Job starting date :
  • Job leaving date :

  • 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.

  • Do you have this as required? Please check YES or No*
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  • SHIFT PREFERENCE

  • Please indicate your work preferences by checking to the relevant box.*
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  • 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.

  • Date*

  • WORK REFERENCES

  • 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.

  • Can we approach your current employer before an offer of employment is made?*
  •  -
  •  -

  • CHARACTER REFERENCES

  • 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.

  •  -
  • Dates you were employed from :
  • Dates you were employed to :
  •  -
  • Dates you were employed from :
  • Dates you were employed to :

  • OVERSEAS CANDIDATES POLICE CHECK INFORMATION

  • 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.
  • Date*

  • DATA PROTECTION STATEMENT

  • 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.

  • Date*

  • EQUAL OPPORTUNITIES STATEMENT

  • 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.

  • FINAL STATEMENT AND DECLARATION

    • 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.

  • Date*

  • EQUAL OPPORTUNITIES MONITORING FORM

  • 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.

  • SEX*
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  • Date of Birth*

  • DISABILITY

  • 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'.

  • Do you consider yourself to be disabled person?*
  • Sexual Orientation*
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  • Religion or Belief*
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  • ETHNIC ORIGIN

    Only check that applies to you.
  • Are you WHITE?*
  • WHITE*
    Rows
  • Are you ASIAN?*
  • ASIAN*
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  • Are you BLACK?*
  • BLACK*
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  • Are you CHINESE?*
  • CHINESE*
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  • QUALITY OF SERVICE MONITORING

  • Where did you hear about us? (select as appropriate for any selection other than Team A5 website, please specify which job board, journal etc.)*
  • How would you rate the service you have received so far.*

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

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