Application form

PRIVATE AND CONFIDENTIAL WHEN COMPLETED
Please complete all sections of this record without exception. You may complete this form electronically, but should you decide to complete in ink, please use a ball point pen with black ink only. Providing deliberately false information may lead to dismissal and even Police prosecution for `Obtaining employment by deception’. 

Data Protection Statement: 


The Company will use the information provided by you on this form, and by the referees you have noted, to process your application for employment. We will treat all personal information with the utmost confidentiality and in line with current data protection legislation.


The information will be subsequently used for the administration of your employment should you be successful in your application and in relation to any legal challenge which may be made regarding our recruitment practices. The information may be crosschecked with third parties. We may also pass the information to third parties with a view to detecting or preventing crime or in accordance with other laws which require us to do so.


Your signature on this application form will be taken to signify your agreement to our processing of your sensitive personal data in accordance with our registration with the Information Commissioner.


Personal Details

Married
Single
Civil partnership
Widowed
Male
Female
Prefer not to say

CV (Please ensure you attach an up to date CV with your past address, employment and qualifaction history)

Application Details

First Responder
Paramedic
Health care assistant
Emergency care assistant
Registered Nurse
Registered Doctor
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
No Applicable
Self employed

Reference 1

Reference 2 (Personal)

Driving Licence details

Declaration

I understand that any offer of employment is subject to the Company being satisfied with the results of series of relevant checks including references, eligibility to work in the UK, criminal convictions, probationary period and a medical report (in line with the operation of the Equality Act 2010).

Prospective Employment Declaration & Disclosure Check  


Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975 (SI 1975 No. 1023) as amended by the Rehabilitation of Offenders Act 1974 (Exceptions) (Amendments) Orders 1986 (SI 1986 No. 1249 & No. 2268)


Due to the nature of the work you have applied for, Section 4 of the Rehabilitation of Offenders Act provides for exceptions to be made from the general rules by order in the disclosure of spent or current criminal convictions.    By virtue of this order, as your prospective employer, we require that you disclose any such convictions/reprimands/cautions on this form.   We guarantee that this information will remain strictly confidential.  All job offers are conditional and subject to Enhanced Disclosure via the Disclosure and Barring Service.   Further information regarding the disclosure can be obtained from the DBS

information line on 0870 90 90 811 or www.disclosure.gov.uk.