Education/Employment
Reference 1
Personal Details
Title
First Name
Surname
Contact Number
Alternative Contact Number
Email Address
Date Of Birth
National Insurance Number
DBS Number
Address Line 1
Address Line 2
City
Post Code
County
Please upload your CV
Max. size: 32.0 MB
Your Bank Details
Bank Name
Sort Code
Account Number
NMC Registration Number (Nurses Only)
NMC Registration Number
Expiry Date
If you are a member of a professional body or union, please state which one?
Right to Work
Are you a British Citizen?
Are you elegible to work in the UK (Evidence will be required)
Have you been convicted of any criminal offence?
If yes please give details
Next Of Kin Details
Full Name
Your Relation?
Address Line 1
Address Line 2
City
County
Post Code
Primary Contact Number
Education History
Institution name
Date from
Date to
What were your qualifications?
Do you hold any further education?
If yes, please give details and dates.
Employment History
Company name
Company Contact Number
Company Address Line 1
Company Address Line 2
City
Post Code
Employer Name
Job Title
Salary
Your Responsibilites
Date from
Date To
Reason for leaving?
Do You hold further employment experience?
if yes, please give details and dates
Reference 1 (Current/Most recent employer)
Please give details of two referees (who should not be your relatives or friends), one of whom should be your previous or current employer. Please indicate against your present employer’s details if you DO NOT wish us to contact them prior to interview.
Full Name
Full Address
Telephone Number
Position
Relationship to applicant
Date from
Date to
Do you wish us to contact them prior to the interview? Please choose as appropiate.
Reference 2
Full Name
Full Address
Telephone Number
Position
Relationship to applicant
Date from
Date to
Medical Questions
First name
Surname
Position Applied for?
Please answer the following questions by ticking (√) the relevant box:
Are you up to date with your immunisations (Hepatitis B, Polio, Rubella, etc) (Evidence of this will be required)
Please select one for each:
Do you suffer from or have you ever had diabetes?
Do you suffer from or have you ever had Epilepsy/fits?
Do you suffer from or have you ever had Repetitive strain injury?
Do you suffer from or have you ever had Back Problems?
Do you suffer from or have you ever had Asthma?
Do you suffer from or have you ever had frequent headaches?
Do you suffer from or have you ever had Fainting or dizziness?
Do you suffer from or have you ever had Rupture/Hernia?
Do you suffer from or have you ever had a mental illness, including depression or anxiety?
Do you suffer from or have you ever had hearing difficulty or loss?
Do you suffer from or have you ever had hearing difficulty or loss?
Do you suffer from or have you ever had any eyesght problems not corrected through the use of spectacles or contact lenses?
Do you take any regular medication?
Equal Opportunities
Be You Care Services Ltd is an Equal Opportunities employer and does not discriminate based on race, gender, disability or sexual orientation. In order to help us to monitor our recruitment in line with these values, please respond to the questions below.
Post Applied for:
Please tick as appropiate:
Gender
Do you have a disibility?
Declaration
I declare that the information I have given on this form is correct and that any misrepresentation by me may be sufficient grounds for my dismissal if I am employed. I give my permission for my previous employer(s) and any reference given to be contacted.
Consent under the Data Protection Act 1998 – The information given to Be You Care Ltd in this form will be processed only by us for the purpose of considering your application for employment. If you are successful in your application this form and the information in it will be retained in your HR file for such time as you are an employee of Be You Care Ltdand for up to 6 years after the end of your employment. Otherwise this form will only be retained by Be You Care Ltd for so long as it is required in connection with your application. By signing this consent you give us your express consent to retain and process all the information contained in this form and to transfer it to countries outside the European Economic area if required.
Please bring the following applicable documents to interview: > Proof of Eligibility to work: > UK Citizen: Passport or full birth certificate with National Insurance Card > Non UK Citizen: Passport or full birth certificate and National Insurance card and Visa/work permit documentation > Name Change Document: if Surname has changed since birth i.e. Marriage Certificate/Deed Poll Photo ID: · Passport · Full Driving Licence (including the Counter Part) Proof of Address: · You will need 2 proof of address that must be within the last 3 months, which can include utility bills, Bank Statement, Council Tax statement etc. DBS (Formerly CRB) Details: · A current DBS must be dated within the last year. Qualifications/training certificates Passport size photo.