Personal Information

       
     
         

Emergency Contact

Professional Registration

             

Professional Indemnity Insurance

Nationality and Eligibility to Work

   
 
 
 
 
 
 
 

Evidence is required of all passports and visas. Please enclose or send scanned copies or photocopies with this application and bring the originals to your first interview. To work in the NHS you will be expected to communicate proficiently in English. All passports and visas will be verified as part of our recruitment procedure.

Educational Qualifications

   

Training

You are required to complete the following practical training on an annual basis. (please tick the relevant courses you have completed and that you will be sending us a valid original certificate)

Training
Place where obtained
Date
Certificate
Manual Training
Basic life support
Immediate Life Support (if applicable)
Food Hygiene
Safeguarding Children and Young People (POCA) Level 2
Additional Training

Previous Work Experience

   

Applicable Experience

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

Payment Details

Please note if you wish to be paid via a limited company then please see below for the documentation that you must provide at the interview, otherwise you will be paid via PAYE until all relevant documents are received.

  • Limited Company Corporation Certificate
  • Limited Company Bank Letter
  • Limited Company Bank Details Form
   

Bank Details

 
 
 

Your Professional Conduct

   

Rehabilitation Of Offendors Act

Convictions will not necessarily be a bar to obtaining a post. However because of the nature of the work for which you are applying, this post is exempt from the provisions of Section 4(2) of the Rehabilitation of Offenders Act 1974. Applicants are therefore required to declare information about convictions, cautions, reprimands and final warnings, for which other purposes are “spent” under the provisions of the Act. Any information given will be completely confidential and will be considered only in relation for positions to which the order applies.

 
 
 
 
   

References

Please provide us with the names of two people who can provide us with a reference as to your suitability for this post. The first one should be your present (or most recent) employer. You should tell us if this is not the case.

Declarations

 
    In accordance to the Working Time Regulations 1998 (as amended), I consent to work in access of 48 hours per week. I understand that I may withdraw this consent by giving Highland Care Agency Limited not less than three months’ notice.