Online Application Form

** Please note that we are currently experiencing problems with our online Application Form. Until this problem can be resolved - please use the PDF version under the 'Jobs' section of the website. We apologise for the inconvenience. Thank You.



Postion Applied For: Details/Reference if provided:
Personal Details:
Surname: Forenames:
Maiden Name: Title:
Address:
Street: City:
Area: Postcode:
Telephone: Mobile:
E-mail:
Do you hold a current UK driving Licence? Do you have the use of/own a vehicle?
Nursing/Care Qualification:
Qualification: Date Achieved:
NMC / SSSC PIN: Expiry Date:
Professional Memberships / Union: Date of Birth:
Employment History - present/most recent first:
Current employer /
Place of Employment:		 Dates (from - to) :
Job Title / Position Held: Main Duties & Responsibilities:
Reason for Leaving: Hourly Rate of Pay:
Name & Address of Employer: Job Title: Dates from/to: Reason for leaving:
Name & Address of Employer: Job Title: Dates from/to: Reason for leaving:
Name & Address of Employer: Job Title: Dates from/to: Reason for leaving:
Education & Training History:
Schools, Colleges
& Universities:		 Qualifications Gained: Dates(s):
Other Training Provider: Subject(s): Dates(s):
Other Employment:
Please detail any other employment you would still continue if you were successful in obtaining this position:
Employment Restrictions:
Are there any restrictions on you taking up work in th UK?
Proof of identity and eligibility to work in the UK are required by all Applicants.
If yes, please provide details:
Referees:
Referee One:
Name:
Position:
Company:
Full Mailing Address:
(including Postcode)
Telephone:
May we approch prior to interview:
Referee Two:
Name:
Position:
Company:
Full Mailing Address:
(including Postcode)
Telephone:
May we approch prior to interview:
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 a 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?
If you answered 'Yes' please provide details:
I also understand that by submitting this online application my details will be submitted for a police check in relation to Adults at Risk & the Child Protection Legislation.
Details of any Disiplinary Offences:
If you have previously worked with vulnerable adults/children, either paid or voluntarily, you are advised that your employer will be asked if you have currently or have ever had any disciplinary warnings issued to you regarding the safety and welfare of service users. If you have had such a warning issued to you, including those which have expired, please give details:
General Comments:
Please detail here your reasons for applying for this post, your main achievements to date and the qualities you would bring to this post. Significantly, please detail how your knowledge, skills and experiences meet the requirements of this role (as summarised in the job description and person specification):
How did you hear about AceHealthcare?
(Please State)
Which other Nursing/Care Agencies do you work for?
Declaration:
By submitting this applicant you confirm that you have read the terms and condtions:
Read Terms & Condtions of Application: Read Declaration Terms
Check details and click here:
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