Compassion Driven Care

Job title you are applying for
Care AssistantRegistered Nurse

NMC PIN

Only if you are a registered nurse*

Name

Date of Birth

Nationality

Phone number

National Insurance Number

Do you hold a full & valid driving license for the UK?
YesNo

How would you like to be paid?
PAYEDirect through UTR or company (Ltd)

Are you eligible to work in the UK?
YesNo

Training and Education

Was your mandatory training - for example moving & handling, infection control, safeguarding, medication admin (RNs only) completed within the last year? Briefly outline any qualifications as well as professional & vocational training that you feel are relevant to this job*

Employment History

Briefly detail your employment history within the past 5 years, starting with the most recent. Please include details of any employment gaps within this period.*

Previous Convictions

Please give details of any convictions in this country or abroad you currently or have previously had. If none, please write the word “NONE” in this box. Please be aware that it is an offence to withhold this information.*

References

Please give details of two people that would be prepared to give you a reference. One must be from a current/previous employer; the other should be a character reference, from someone other than a family member. Any offer of employment will be subject to satisfactory references. By entering their details here, you give Redemption Healthcare Ltd. permission to contact these people. Please include Name, Position, Organisation, Address, Email and Phone Number.*

DBS status. Have you subscribed for the DBS Update Service? Please select.
YesNo

If you selected "Yes", please enter the number of the DBS certificate you subscribe with? Please note this is the DBS certificate number, not your subscription number.

Health and Safety - Do you have a disability of any kind that may affect your work? please select
YesNo

If you selected "Yes", please give details …

Working Preferences
Day ShiftsNight ShiftsWeekdaysWeekends

How many days/nights per week?
OneTwoThreeFourFlexible

Online data - We keep many of your records securely online. In addition, clients may ask that these are uploaded and shared online with their own client base (e.g. nursing & care homes), prior to the commencement of your first shift with them. Do you authorize that these details can be shared with them online?
YesNo

Working time regulations - the maximum working week is currently limited to 48 hours. As you are under no obligation to accept any work offered, you will not be compelled to work more than 48 hours per week. However, you may choose to do so. Please select.
I DO NOT wish to work more than 48 hours per weekI DO wish to work more than 48 hours per week

Data Protection Our records, including any copies of documents supplied are kept securely in line with GDPR regulations. You understand & give permission for these to be made available from time to time to authorized personnel or inspectors, Home Office Immigration Check. If applicable, you understand & give permission for Redemption Healthcare Ltd. to contact the appropriate authority in order to verify your current immigration status. Please tick.
Yes

Upload supportive documents such as a copy of your Passport or Driving License

Declaration - I confirm that I have read and understood the above and confirm my answers to be accurate and correct. Additionally, I understand that … It is my responsibility to update Redemption Healthcare Ltd. in the event any of these details change in the future. Any job offer made to me is based on a zero-hours contract with no guarantee of work or working hours. Any job offer made to me is subject to satisfactory references being obtained from the individuals offered above. I give permission for Redemption Healthcare Ltd. to contact the referees given. Upon acceptance, if I do not subscribe to the DBS Update Service, Redemption Healthcare Ltd. will arrange a Disclosure and Barring Service (DBS) check now, and at intervals thereafter. I agree to pay the cost of this, determined at the time, either through deductions from my wages, or paid directly by me after three months from the DBS request being made, whichever is sooner. I also understand that Redemption Healthcare Ltd. may contact the Home Office/UK immigration in order to verify my eligibility to work in the UK. If information given on this application form is found to be false it may result in disciplinary action, or dismissal.
I Agree

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