Application Form - CR - Sonderwell

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Application Form -v1.2 CR

- Step 1 of 8

Thank you for applying for work with Better Healthcare Services. To be able to complete the interview we will require you to bring documents and evidence from the below list. If you are able to upload the files, this will save time at interview.

Title

Mr
Mrs
Miss
Ms
Dr
Mx
Other

Name *

First

Last

Known as / preferred name

Proof of ID - please choose 2 (one must be photo ID)

Passport
Driving License
Birth Certificate
Citizens Card
Work Permit

Proof of ID 1

Click or drag a file to this area to upload.

Proof of ID 2

Click or drag a file to this area to upload.

Proof of Address - please choose 2 (must be within the last 3 months)

Energy Bill
Bank Statement
Phone Bill (landline)
Credit Card Statement
P45 / P60

Proof of Address 1

Click or drag a file to this area to upload.

Proof of Address 2

Click or drag a file to this area to upload.

If you are unsure of your NI number you can find it from this HMRC site: https://www.gov.uk/government/publications/national-insurance-get-your-national-insurance-number-in-writing-ca5403

Training Certificates (sent as one file)

Click or drag a file to this area to upload.

Name *

First

Last

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Home Phone

Mobile Phone *

Email *

Passport Number *

National Insurance Number *

If a nurse, please enter your NMC PIN

Do you drive?

Yes
No
I have another form of transport

Do you have your own car - or access to a car?

Yes
No

How did you hear about Better Healthcare *

Please state *

Please state *

Next of Kin

Name *

Next of Kin

Relationship *

Next of Kin

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Home Phone

Mobile *

Email

Professional / Vocational Qualifications:

Name of Professional Body - GMC, NMC, Professions Allied to Medicine etc

Membership Grade and/or Registration

Date of expiry MM/YY

References

Please supply referees for the past 5 years

Reference 1

Reference 1

Name: *

Position: *

Organisation: *

Phone

Email *

Worked From MM/YY *

Worked To MM/YY *

Reference 2

Name: *

Reference 2

Position: *

Organisation: *

Phone

Email *

Worked From MM/YY *

Worked To MM/YY *

Reference 3

Name:

Reference 4

Position:

Organisation:

Phone

Email

Worked From MM/YY

Worked To MM/YY

Ethnic Origin

Please select your ethnicity

White

White
Scottish
Irish
Welsh

Mixed

White and Black Caribbean
White and Black African
African

Black or Black British

Caribbean
White and Asian

Asian or Asian British

Indian
Pakistani
Bangladeshi

Chinese or other ethnic group

Chinese

Other please state

Right to Work in the UK

I confirm I am entitled to work in the UK on the following basis:

I am a UK Citizen

Date from - (if from birth, please enter your Date of Birth)

I hold a valid work permit

Date from

I hold a Working Holiday Visa

Date to

I hold an Ancestral Visa

Date to

I am eligible to work in the UK under my spouses Visa

Date to

I hold a highly skilled Migrant Programme Visa

I hold a Student Visa

Other - please specify

Single Line Text

Is your partner, any member of your family or household employed by the company?

Is your partner, any member of your family or household employed by the company? *

Yes
No

Name

Job Title

Branch

Rehabilitation of Offenders Act 1974

By virtue of the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975, the provisions of Section 4.2 of the Rehabilitation of Offenders Act 1974 do not apply to any employment which is concerned with the provision of health services and which is of such kind as to enable the holder to have access to persons in receipt of such services in the course of his normal duties. Your answer to the following question should include any ‘spent’ convictions.

Have you ever been convicted of a criminal offence? *

Yes
No

Please give details below

Data Protection Consent Form (GDPR)

I hereby give my consent to Better Healthcare Services to process the following information about me: • Name • Date of Birth • Contact details, including telephone number, email address and postal address • Experience, Staff Performance, training and qualifications • CV • National Insurance Number • Payroll / Tax • Bank Details • GP Details • Next of Kin Detail • Passport • Driving License • Right to Work in the United Kingdom/Visa • Proof of references Sensitive Personal Detail • Disability/health condition relevant to the role • Criminal conviction • Disciplinary Information • Religion • Ethnic Origin Contact • I am happy to be contacted by email, text message, phone or post I consent to Better Healthcare processing the above personal data for the following purposes: Where I have delivered care on behalf of the company, I also consent to the Company processing my personal data with third parties for the purposes of internal audits and investigations carried out on the Company to ensure that the Company is complying with all relevant laws and obligations - this includes CQC, local authority, NHS. Managed Service Providers and clients within the care industry. The consent I give to the Company will last for 3 years or 6 years (from the time I leave Better Healthcare) where I have worked as a carer. I am aware that I have the right to withdraw my consent at any time by informing the Company that I wish to do so.

Data Protection Consent - I hereby give my consent

Data Protection Consent

GDPR Agreement *

I consent to having this website store my submitted information so they can respond to my inquiry.

Declaration

I affirm that the information set out in this form is true and correct, is not misleading and that no material information has been omitted. I understand and agree that if I submit any false or misleading information or omit any material information this may result in an offer of employment being withdrawn or, if I have already I understand and agree that I have read the conditions of Better Healthcare Services and agree to be bound and comply with the same. I confirm that under the General Data Protection Regulation (GDPR) 2018, I hereby give my full consent to Better Healthcare Services to verify all the information given on this form and to process the information as described above under 'Data Protection Consent'. I have read and understood the Standard/ Enhanced DBS Check Privacy Policy for applicants (this can be found in our Policies and Procedures file or on the Better Healthcare web site under 'downloads' www.betterhealthcare.co.uk/ downloads

I confirm the declaration above

Declaration

Declaration

I declare that the information on this form is true to the best of my knowledge. Further, I understand that if I should be found to knowingly make a false statement regarding my medical history either in answering the above questions or to the Company's Director of Quality and Training, or should I conceal any material fact, the Company can terminate my contract without notice.

Name *

First

Last

Name

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Trinity Court
Molly Millars Lane
Wokingham
Berkshire
RG41 2PY

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