call

0800 669 6712 mail

mail

compliance@careplushealthcare.uk

THE UK’S LEADING HEALTHCARE RECRUITER

New Candidate

Application Form

Please complete all sections of the application form as the information provided will be used as part of the selection process.

PLEASE COMPLETE FULLY IN CAPITALS

Date application form filled in:*

Position applied for:*

Full-time 7am to 10pm/Part-time 7am*

What is your availability?*

Forename:*

Surname:*

Current address:*

Dates at this address:*

Telephone number:*

Previous addresses and dates moved in and out covering the last 5 years (for your DBS):*

Do you have a clean DBS:*

Do you have a Car and a Clean Licence:*

National Insurance Number:*

Endorsements:*

Insurance Business class1:

YesNo

Date expire:*

CAPACITY TO WORK IN THE UK

Do you have Work Permit?

Give details:*

BRP Number:

Give Share Code :*

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

YesNo

If yes, please provide details:*

If you are successful in the application, would you require a work permit prior to taking up employment?:*

YesNo

EDUCATION

School/College/University:*

Examinations Passed/Qualifications Gained :*

(Please supply copies of certificates):*

TRAINING HISTORY/PROFESSIONAL STATUS (relevant to position applying for)

Date of Graduation/Qualification

Location/Details

Notes:

(Please supply copies of certificates/membership details):

EMPLOYMENT HISTORY

Current or most recent Employer first. Information must cover at least the last 5 years. State the reasons for any breaks in employment. Use a separate attached sheet if required; please sign that sheet(s).

Name and address of Employer prior to the employer listed above:

Nature of business:

Salary/Rate:

From(Date employed):

To:

Position held and reason for leaving:

Name and address of Employer prior to the employer listed above:

Nature of business:

Salary/Rate:

From(Date employed):

To:

Position held and reason for leaving:

Name and address of Employer prior to the employer listed above:

Nature of business:

Salary/Rate:

From(Date employed):

To:

Position held and reason for leaving:

Name and address of Employer prior to the employer listed above:

Nature of business:

Salary/Rate:

From(Date employed):

To:

Position held and reason for leaving:

Name and address of Employer prior to the employer listed above:

Nature of business:

Salary/Rate:

From(Date employed):

To:

Position held and reason for leaving:

Were there gaps in your employment history?

YesNo

If yes, give details of activities involved in during the gap:

Please give details of relevant experience. This may be taken from work situation, voluntary work, charity or your own home. Please use a separate sheet if insufficient space is available.

REFERNCES/N.O.K DETAILS

You must provide references from your two most recent employers. Please provide an additional character referee if you cannot supply the two most recent. 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

Name:

Address:

Postcode:

Tel No:

Email:

Job Title:

Previous employer to the one above

Name:

Address:

Postcode:

Tel No:

Email:

Job Title:

Character reference

Name:

Address:

Postcode:

Tel No:

Email:

Job Title:

Next of kin

Name:

Address:

GP’s name:

Postcode:

Tel No:

Email:

Job Title:

Declaration

To Be Signed By All Applicants

To the best of my knowledge the answers to the questions on this form are correct. I understand that if I knowingly with-hold information or give a false declaration, this may have implications with my employment.

Form Completed by(Name)

Signature:

Date:

Proof of Identity Document

Original documents only–no photo-copies	I confirm that I have seen the original documents, signed for to confirm the identity of the applicant (signed by interviewer)	Date
1. Photographic
Passport/New driving license
And/or (with one of the above)
Birth Certificate/other certificates with name changes i.e:-Marriage
2. Proof of Address x2
Utility bill, Credit card statement, Bank statement, Council tax bill correct name and address, and 3 months old. If other, please identify what and dates
IMPORTANT:TAKE PHOTO COPIES OF THE ORIGINALS AND PLACE IN THE SECTION OF THEIR PERSONAL FILE IF SUCCESSFUL.

Note: Minimum age legislation dictates that Care workers in general must be 18years old or older. Please inform your interviewer immediately if you do not meet these specifications.

What’s Next?

Thank you for completing your application with CarePlus Healthcare. Please return this form and all supporting documentation to your dedicated CarePlus Healthcare recruitment consultant by hand, post, scan or email.

T: 0800 669 6712

E: compliance@careplushealthcare.uk

W: www.careplushealthcare.uk

Always open

CarePlus Healthcare provides a 24/7 service to its candidates and clients, meaning we’re always available by phone - 24 hours a day, 7 days a week, 365 days a year.

The information provided will be used as part of the selection process. All information and documentation provided will now be processed through our Compliance department. Following this your dedicated recruitment consultant will be in contact with you to provide the best opportunities to suit your requirements.

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