J Rose Care Ltd Agency Staffing Solutions Toggle NavigationHomeJobsContactHomeJobsContact APPLICATION FOR EMPLOYMENT FORM Title (Mr, Mrs, Miss, Ms, etc.):*Forenames:*Surname:*Post applied for:*Registered NurseHealth Care AssistantEmail AddressContact number:*Do you have the right to take up employment in the UK?*YesNoIf you do not have the right to take up employment in the UK, would you wish us to assist you in applying for the right to work?YesNoDOB:*National insurance number:Education & Professional Qualifications:- In chronological order starting with most recent first (Qualifications disclosed will be subject to a satisfactory check)Gaps in work.Please give details of, and provide an explanation for, any time when you were not either working or in full-time education. Other Information:*Please use this space to say why you are interested in the post for which you have applied and provide any other information that may assist your application.Postgraduate education or study or any other professional qualifications:Establishment / Qualification gained / Date achievedNMC PIN NO:Do you have any other training, qualifications or skills relevant to the post?Employment history:Please give details of your last five years of employment, beginning with your present or most recent. Any relevant posts held before then may also be mentioned.What are your salary expectations? :Referees: Please give details of two referees, one of whom should be your current or most recent employer or, if this is an application for your first job, your school teacher or higher or further education lecturer. If you are unable to provide two working references you may provide a character reference, however this should be somebody who knows you in a professional standard, and must not be a relative or friend. (Note: References will not be taken up prior to any offer of employment being made) :First referee Address: Post Code: Telephone: Email: Second referee Address: Post Code: Telephone: Email:Rehabilitation of Offenders Act 1974 In order to protect the public, the post you have applied for may be exempt from certain provisions of the Rehabilitation of Offenders Act 1974. You may therefore be required to disclose all and any past or pending cautions or convictions, whether spent or otherwise, unless it is either a “protected caution” or a “protected conviction” under the terms of the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975. All information provided will be kept in the strictest confidence and only used for the purpose of assessing your suitability for the post you have applied for. Please specify below details of all and any past or pending cautions or convictions, whether spent or otherwise, except for protected cautions or convictions. If you have no past or pending cautions or convictions, please specify “None”.*If you are successful in obtaining a position with the Company, depending on your role you may be required to undertake a Disclosure and Barring Service check, Financial Regulations Screening, and any other screening deemed applicable to the role. Please confirm that you give the Company authority to undertake such checks should you be offered employment by ticking the box and signing the declaration below:*I give the Company authority to carry out the screening detailed above as relevant to my role and understand that further details of such checks will be notified to me should my application be successfulDeclaration*I declare that the information I have given on this form is, to the best of my knowledge, true and complete. I understand that if it is subsequently discovered any statement is false or misleading, or that I have withheld relevant information, my application may be disqualified or, if I have already been appointed, I may be dismissed. I hereby give my consent to the Company processing the data supplied on this application form for the purpose of recruitment and selection. I accept that if my application is successful, this application form will form part of my Personnel file and, in that case, I consent to the data on it being processed for all purposes in connection with my employment.This site uses Google reCAPTCHA technology to fight spam. Your use of reCAPTCHA is subject to Google's Privacy Policy and Terms of Service.SUBMITThank you for submitting your application.0 / PreviousNextPausePlayClose