Application 2022

Step 1 of 15 - Job Details

Applicant location?

Overseas

Position applied for*

Approx. no. of hours wanted

Job type*

Full-time

Part-time

Preferred shifts*

Days

Nights

Weekend only

Personal details

Full Name*

First name(s) Surname

Previous surnames

(Supply documentary evidence e.g. marriage certificate, deed of name change etc):

Current address*

Street Address City ZIP / Postal Code

Time at this address?*

Please enter previous address

Previous address	Postcode	Moved to this address on (date)	Actions

There are no Previous Addresses.

Note: For Criminal Record check purposes, addresses covering the five years up to the application date must be supplied. If necessary, use another sheet of paper.

Contact details

Your email address*

Your mobile number*

Home telephone number

Transport

Own transport*

Yes

Clean current driving licence*

Yes

Endorsements*

Identity

Nursing and Midwifery Council PIN number*

(Nurses only)

National Insurance Number

Are you part of a union?*

Yes

Union name*

Union number*

School / College / University	Examinations Passed/Qualifications Gained	Actions

There are no Entries.

Subjects	Grade/qualification received	Actions

There are no Entries.

Employment

Are you currently employed?*

Yes

Current Employment

Current employer name*

Date started*

Employer address

Street Address City ZIP / Postal Code

Nature of business*

For example, care agency etc.

Position held*

Salary / Rate*

Previous employment details

Previous Employment

Employer name	Address	Date started	Nature of business	Position held	Reason for leaving	Salary / rate	Actions

There are no Entries.

Next of kin

Full name*

Relationship*

Telephone number*

Address*

Street Address City ZIP / Postal Code

Right to work

Nationality*

Do you have a right to work in the UK?*

Yes

Which visa/passport/settle scheme authority do you have?*

GP Details

(Your GP will never be contacted without your permission)

GP's name

Telephone number

Address

Street Address City ZIP / Postal Code

Referees

You must provide references from your two most recent employers. The email you submit will be used to obtain a reference in the first instance. Both will be contacted, therefore 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 and put N/A in the text boxes

Current company name*

Job title*

Telephone number*

Current employer address*

Street Address City ZIP / Postal Code

Current employer email address*

Previous employer(s) to the one above

Previous company name*

Job title*

Telephone number*

Previous employer address*

Street Address City ZIP / Postal Code

Previous employer email address*

Criminal Record

Workers of The Agency are subject to the Health and Social Care Act 2008, and will be subject to a Police Record Check through the DBS. Please declare all criminal convictions, whether spent or not, charges, whether proceeded with or not, and warnings and cautions.
Please note, you may not be eligible for work in a Care setting if you are on the DBS Register(s).

Do you have a criminal record?*

Yes

Please declare all criminal convictions, whether spent or not, charges, whether proceeded with or not, and warnings and cautions in the space provided below.

Bank Details

Please enter your payment details where you wish to be paid. We take your privacy and security very seriously, our system is SSL secured and protected, to prevent any hacking attempts.

Name on card*

Sort code*

Account number*

Is the account in your name?*

Yes

Please upload pictures or PDF scans of your identity documents, these must be no larger than 5 MB (each file)

REQUIRED FILES

Valid Passport*

Proof of address*

Bank Statement within 3 months or Utility Bill within 3 months

Passport size photograph*

Visa / residence permit*

Optional Uploads

National Insurance Number Proof

Driving Licence Front

Driving Licence Back

Qualifications Certificates

Training Certificates

This includes Manual Handling, Fire Safety, Infection Control, Health and Safety, Safeguarding Adults, Food Hygiene, First Aid, Medication Administration and other relevant training for example

Current valid enhanced DBS

DATED WITHIN 3 MONTHS OR ON THE UPDATE SERVICE. We can carry out a new one for £55

Immunisation records & proof of Covid vaccinations

Current CV

Please upload pictures or PDF scans of your identity documents, these must be no larger than 5 MB (each file)

REQUIRED FILES

Valid Passport*

TB UKVI Test*

Police Report UKVI*

ILETS UKVI English Test*

Full CV*

Demonstrating experience in care work

Academic Certificates*

Diploma / Degree

One Passport Size Photo*

2 Professional References*

1 Character Reference*

International Driving License*

Healthcare Training Certificates*

Covid Vaccination Certificate*

Optional Uploads

Optional Supporting Documents

SIGNATURE & DECLARATION - IMPORTANT - READ BEFORE SUBMITTING

I declare that to the best of my knowledge and belief the information given by me in this application is true, and I understand that the above information forms the basis of my contract of employment. I understand that if any of the information supplied by me is found to be falsely declared, my contract may have been fundamentally breached and my employment may be terminated immediately.

I understand that I may not be offered a post until a satisfactory response has been received with respect to my DBS Register status, and that should I subsequently be offered a post, that offer will be subject to receipt of two satisfactory references, one of which must be from my previous employer, and that confirmation of the employment will be subject to a satisfactory criminal record check from the DBS.

I understand that until a satisfactory response is received from the DBS, and my employment is confirmed, I will be supervised at all times at work, and will not seek or have unsupervised access to vulnerable people. If the post I have applied for is as a Registered Nurse, my confirmation of employment will also be subject to a satisfactory search of the Nursing and Midwifery Council records and registers. By my signature, I authorise Responsive-Care to request a DBS Register check and a criminal records check from the DBS, on initial employment and at any time during my employment thereafter. I undertake to inform my employer immediately if my DBS Register status or criminal status changes at any time during my employment, such as by being charged with an offence (other than motoring offences), the administering of a warning, criminal conviction, referral to any register of barred Care workers, or withdrawal of any registration required by my employment status.

I authorise Responsive-Care to conduct a reference check with my present and/or previous employer(s) and other referees. I understand that reference information may include, but not be limited to, verbal and written inquiries or information about my employment performance, professional demeanour, rehire potential, dates of employment, salary and employment history. My digital signature authorises my former or current employers and referees to release information regarding my employment record with their organisations and to provide any additional information that may be necessary for my application for employment with Responsive-Care, whether the information is positive or negative. I knowingly and voluntarily release all former and current employers, referees, and Responsive-Care from any and all liability arising from their giving or receiving information about my employment history and my suitability for employment with Responsive-Care.

Signature*

CAPTCHA

Personal details

Contact details

Transport

Identity

Employment

Current Employment

Previous employment details

Next of kin

Right to work

GP Details

Referees

Previous employer(s) to the one above

Criminal Record

Bank Details

Equal opportunities monitoring

Ethnic origin

Religion or belief

Social mobility

Disability

SIGNATURE & DECLARATION - IMPORTANT - READ BEFORE SUBMITTING