Application Form Nurse

Application Form Nurse

Data Protection Statement

The personal information (data) collected on this form, and on the attachments, (which includes the collection of sensitive personal data) are collected for the purposes of recruitment, personnel administration (for new employees) and monitoring. Unless you direct otherwise (for example in a situation where you would like this Application kept on file for future vacancies) the Application Forms (and attachments) of unsuccessful applicants will be destroyed after 6 months. It is the policy of the Agency to protect, and keep secure, all personal data collected. All personal data is processed for the purposes of recruitment, and, in the case of successful Applicants, for the satisfactory administration of their employment, and for no other purpose.

Equality of Opportunity Statement

The Agency’s Equal Opportunities Policy covers all employees, or potential employees, and embraces the principle that all people shall be treated equally, regardless of their age, gender, ethnic origin, nationality, colour, religion, marital status, sexual orientation, religion or belief, disability, or offending background.

1. Personal Details
2. Formal Education and Qualifications
3. Employment History
4. Training

eg. Manual handling, CPR, infection control, first aid etc, (please provide certificates)

5. Professional Details

The service we give depends on accurate up to date information. Please keep us informed of all developments in your career.
To assist us in finding suitable work for you, please tick all nursing specialities of which you have significant, post training experience.

Please include the number of years experience and any certificates or qualifications you have in the above specialties.

Infection Control

Please select you level of proficiency of each task from the options below

6. General Information
7. Preference Regarding Work

Please specify which types of work you would prefer. You should tick all appropriate boxes. The service we give depends on accurate, up to date information. Please keep us informed of all developments, in your career and work preferences.

8. Immunisations - proof of immunisations must be provided

Please select the immunisations you have and the date from the options below.

9. References

References are normally taken up for candidates selected for interview. Give details of the names/addresses of two work-related Referees. One of the Referees should be your current employer, or if presently unemployed or self-employed, your last employer.

10. Confidentiality declaration

Registration implies acceptance of our code of confidentiality.
In the course of your duties you may have access to confidential information about your clients. On no account must information relating to identifiable clients be divulged to anyone other than the manager of the agency. You should not disclose ANY information to your family, friends or neighbours.
If you are worried by any information you have obtained and consider that you should talk about it to someone else MAKE AN APPOINTMENT TO SPEAK IN PRIVATE TO YOUR MANAGER.
Failure to observe these rules will be regarded as serious misconduct which could result in removal from the agency register.

11. Rehabilitation of Offenders Act

As a general rule, no-one need answer questions about spent convictions. However this general rule does not apply to specified professions, employments and occupations. By virtue of the Rehabilitation of Offenders Act 1974 (Exceptions) (Amendment) Orders, the exemption rule does not apply to:
a) any employment or other work which is concerned with the provision of health services and which is of such a kind as to enable the holder of that employment or the person engaged in that work to have access to persons in receipt of such services in the course of his normal duties, or
b) any employment or other work which is concerned with the provision of care services to vulnerable adults and which is of such a kind as to enable the holder of that employment or the person engaged in that work to have access to vulnerable adults in receipt of such services in the course of his normal duties
One or both of the above apply to work with the Agency, and covers all occupations.
You are therefore requested to provide details of all convictions, including those which would otherwise be considered as “spent”. All employment applications will be considered carefully, and the disclosure of a conviction does not imply that this employment application will be rejected.

Criminal Records – Disclosure Certificate

Disclosure Scotland have issued a Code of Practice regarding Disclosure Information, a copy of which is available upon request. A PVG Certificate (standard or enhanced) will be requested from Disclosure Scotland which will detail all convictions, including those which would otherwise be “spent”, as well as details of cautions, reprimands or final warnings. You will be advised of the type of certificate being requested, and asked to give your approval to this application. The PVG Certificate will only be requested in the event that you are successful in your application for employment.

Asylum and Immigration Act 1996

Under Section 8 of the Asylum and Immigration Act 1996 it is a criminal offence to employ a person aged 16 or over who is subject to immigration control unless:
That person has current and valid permission to be in the United Kingdom and that permission does not prevent him or her from taking the job in question; or
The person comes into a category specified by the Home Secretary where such employment is allowed
Any employment offered will be subject to the successful applicant producing appropriate evidence that the Asylum and Immigration Act is not being contravened.

Personal Declaration

I declare that to the best of my knowledge the above information, and that submitted in any accompanying documents, is correct, and
I give permission for any enquiries that need to be made to confirm such matters as qualifications. experience and dates of employment, and for the release by other people or organisations of such information as may be necessary for that purpose.
I give permission for the processing of the personal data contained in this form for employment purposes
I understand that any false or misleading information could result in my dismissal.

12.Equal Opportunities Monitoring Form

A1 Care operates a policy of Equal Opportunities: therefore, we need to be able to check that decision are not influences by unfair or unlawful discrimination. To help use to do this we would be grateful if you could complete this short questionnaire. Your answers will be treated with the utmost confidence and will be used only for statistical purposes.

Choose ONE section from A to E, and then circle the appropriate box to indicate your cultural background.

Applicants with disabilities will be invited for interview if the essential job criteria are met. Do you consider yourself to be a person with a disability as described by the disability discrimination act 1995? i.e do you consider yourself to be someone who has a physical or mental impairment which has a substantial and long term adverse effect on your ability to carry out normal day to day activities?