Staff Application Form

Staff Application FormRedWebsiteDesign2021-11-15T10:36:29+00:00

Name(Required)

Prefix First Last

Gender(Required)

Date of Birth(Required)

NI Number(Required)

Marital Status(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone(Required)

Mobile(Required)

Email(Required)

Right To Works In The U.K.*

EU Citizen

Spouse of an EU Citizen

Work Permit

Permit Free Visa

Right of Abode in the UK

Admitted to UK as Doctor Prior to 1985

Indefinite Leave To Remain

Limited Leave To Remain

Other

Other Visa Type

Passport Expiry Date

Visa Expiry Date

Do you have a current DBS Disclosure (formally known as CBR)

Yes

DBS Expiry Date

DBS Issue Date

Do you have a driving licence?

Yes

Do you have use of a car?

Yes

Do you have any Driving Offences within the past 5 years?

Yes

If selected for employment are you willing to submit to submit to a per-employment drug screening?

Yes

Do you have any convictions?

Yes

Which are not yet spent (i.e. unspent) under the terms of the Rehabiliation of Offender Act 1974 (Exceptions ) Order 1975 (as amended in 2013)

Do You Require Special Provisionsto be made to assist or enable you during interviews or assessments?

Yes

Education

What is your highest level of Education?(Required)

Please List all Past Education (Include Institution, Level, Awards and Dates)(Required)

Other Traning Certificates (Include Dates and Providers)(Required)

Professional Registrations (Include Registration Numbers and Dates)(Required)

Upload your Passport

Drop files here or

Max. file size: 256 MB.

Upload Your Visa

Drop files here or

Max. file size: 256 MB.

Upload Your CV

Drop files here or

Max. file size: 256 MB.

Upload Your Cover Letter

Drop files here or

Max. file size: 256 MB.

Employment History

(Recent/Current) (Please provide the last three employers where possible)

Employer

Start Date

End Date

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Pay Rate / Hr

Position

Notice Period

Reason for Leaving

Manager's Name

Work Phone

Duties

More Employment History

Employer

Start Date

End Date

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Pay Rate / Hr

Position

Notice Period

Reason for Leaving

Manager's Name

Work Phone

Duties

More Employment History

Employer

Start Date

End Date

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Pay Rate / Hr

Position

Notice Period

Reason for Leaving

Manager's Name

Work Phone

Duties

Please list all other previous employment which you think might help with the current position (Employer/ Employment/ Dates/ Duties).

References

Name 1

Prefix First Last

Position / Relationship

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

May We Contact Them?

Yes

Name 2

Prefix First Last

Position / Relationship

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

May We Contact Them?

Yes

Declarations

Consent(Required)

YES I certify that all answers given are true and complete to the best of my knowledge.(Required)

Consent(Required)

YES I authorise investigation of all statments contained in this application for employment as may be necessary in arriving at an employment decision.(Required)

Consent(Required)

YES In the event of employment, I understand that false or misleading information given in my application or interview may result in discharge.(Required)

Consent(Required)

YES I concent to my data being collected, processed and stored from this form in accordance with the relavant Data Protection and Protection Laws.(Required)

Date Completed(Required)