Application form

INFORMATION FOR DISCLOSURE SCOTLAND CHECK

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EDUCATION HISTORY

Include in this section all the relevant qualifications. Please also indicate subjects currently being studied

EMPLOYMENT REFERENCES

Please provide the full name and work address of two professional clinical referees. These should cover 3 years of employment and must contain your current / most recent employer. Your current employer must be able to comment on your ability to do the job you are applying for. Your referees must be a senior grade to yourself. Additional references may be required in order to cover the 3 year period.

Please sign in agreement for your referees to be contacted

Full Employment History

Previous Employment: Please include any previous experience (paid or unpaid), starting with the most recent first.

Current or most recent employer

Previous employer

Previous employer

Additional Supporting Information

What excites you about the position you have applied for and what sorts of things have you been doing that you think could help you become a good at this job?

Please can you tick the values that are most important to you:

EXPERIENCE

Please tick if you have worked in any of the following facilities:

SKILLS / AREA

Please tick the area you have experience in:

By selecting the above information you are stating your clinical ability to work in those areas. Should it be found that you are clinically unable to work in those areas, you accept that the company may take disciplinary action against you.

BANK DETAILS

Tax Status

Form Attached

LIMITED COMPANY

If you have a limited company please ensure you attach the following information:

Proof of UK Limited Company Registration (Certificate – paper copy)

Proof of Directorship of Ltd Company

Proof of RCN/RCM Membership

Signed Limited Company Contract

Confirmation that the Ltd Company is either VAT exempt or that you will absorb the VAT % when supplying to clients that are VAT exempt.

Proof of UK VAT Registration if relevant (Certificate – paper copy)

Limited Company bank statement or letter of confirmation from your bank showing your bank details.

Email address for payment advice to be sent to

DECLARATIONS

Please ensure that all declarations are ticked

DATA PROTECTION

I agree that Senior Carers retains the right to hold this application and any other data associated to process it and pass on to any authorised third party the details held within, also to retain the details for as long as reasonably necessary in accordance with the Data Protection Act 1998

The European Union has laid down guidelines for all workers, governing the length of the maximum working week that is safe to work. The current limit is 48 hours per week. You are under no obligation to accept any work offered, and you will not be compelled to work more than 48 hours per week, however you may choose to do so. A full explanation of the Working Times Regulations 1998 can be found in your Staff Handbook. Please tick the appropriate box.

Whilst working for the agency, the temporary worker will accumulate Holiday Pay calculated as a percentage of the hourly rate of pay. We co-ordinate leave from April to April. All requests must be made within the correct time period. Should you request later than 31st March you will no longer be entitled to holiday pay for the previous year. If applying for holidays, the temporary worker must give a minimum of 2 weeks notice to the Registered Manager at the agency. I have read, understand and will comply with the Working Holiday Entitlement Clause. For the purposes of your employment with us, the holiday year will be the 12 month period commencing on the 6th April (and, if applicable, each subsequent 12 month period). All entitlement to leave must be taken during the course of the holiday year in which it accrues and none may be carried over into the next holiday year. The agency is not required by law to make any payment in lieu of unused holiday at the end of the holiday year. When making your holiday plans please observe the following: Notice must be given of either 1 week or by the total length of the holiday, whichever is the greater.

Nurses are expected to adhere to the NMC code of conduct and drug administration guidance. Carers ans Support workers are expected to act in agreement set in SSSC Codes of Practice. Are you fully aware of these and agree that you will apply them at all times during your employment?

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I have read, understood and accept the ‘Terms of Engagement for Temporary Workers’ contract. This is provided as a separate document for you to keep for your records.

TERMS AND CONDITIONS

I hereby confirm that the information given is true and correct. I consent to my personal data and employment/educational history being forwarded to clients. I understand that should the information I have given be untrue I accept full responsibility for any consequences this may bring. I consent to references being passed onto potential employers. If, during the course of a temporary assignment, the client wishes to employ me direct, I acknowledge that the agency will be entitled either to charge the client an introduction/transfer fee, or agree to an extension of the hiring period with the client (after which I may be employed by the Client without further charge being applicable to the Client). We may check the information collected, with third parties or with other information held by us. We may also use or pass to certain third parties information to prevent or detect crime, to protect public funds, or in other way permitted or required by law.

Due to the nature of the work you are applying for, this post is exempt from the provision of section 4 (2) the rehabilitation of offenders act 1974 by virtue of the rehabilitation of offenders act 1975 (exception) order 1975 applicants are therefore, not entitled to withhold information about convictions which for any other purpose are ‘spent’ or ‘unspent’ under the provisions of the act and in the event of employment. Failure to declare a conviction may require us to exclude you from our register or terminate an assignment if the offence is not declared but later comes to light. Any information given will be completely confidential and will be considered only in relation to an application for the positions where the order applies and should be entered at the end of any particulars you give in support to this application.

In line with UKBA guidance on the prevention of illegal working we will need to verify and take a copy of your original ID documentation as evidence of your right to work in the UK if you are to be engaged by us for temporary work.

If you are applying for a post that requires professional registration you are required to provide the following information:

Are you currently the subject of a fitness to practise investigation or proceedings by a licensing or regulatory body in the UK or in any other country?

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Have you been removed from the register or have conditions been made on your registration by a fitness to practise committee or the licensing or regulatory body in the UK or in any other country?

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SECURITY CHECKS DISCLAIMER

In line with the nature of the work I will be undertaking, I understand that there will be necessary security checks carried out and consent to this

I have received a copy of the Staff Handbook and read through all content. I understand all the policies and procedures and will abide by the code of conduct at all times.

In line with the nature of the work I will be undertaking, I understand that the confidential documentation I have given in line with compliance procedures may be audited in relation to the provision of the services at any time and I consent to this.

I have received the agency’s AWR policy. I have read and understood the terms.

We are committed to a policy of equal opportunities for all work seekers and shall adhere to such a policy at all times and will review on an on-going basis on all aspects of recruitment to avoid unlawful or undesirable discrimination. We will treat everyone equally irrespective of age, transgender, race including colour, nationality, ethnic or national origin, religion, belief or lack of religion or belief, sex or marital or civil partnership status, or membership or non-membership of a Trade Union and we place an obligation upon all staff to respect and act in accordance with the policy. The agency shall not discriminate unlawfully when deciding which candidate/temporary worker is submitted for a vacancy or assignment, or in any terms of employment or terms of engagement for temporary workers. The agency will ensure that each candidate is assessed only in accordance with the candidate’s merits, qualification and ability to perform the relevant duties required by the particular vacancy.

We are always looking for fantastic, friendly and fabulous nurses, Support Workerss, SeniorCarers and Care Assistants! If you enjoy the freedom of working for an agency, and know someone who would also like to join our team then we would love to hear from you.