Employment Application Form

Post Applied For*

Please specify the position:*

Personal Details

First Name*

Last Name*

Date Of Birth*

Select Gender*

Ethnicity

Select Nationality*

Phone Number*

Home Telephone Number

Email Address*

Complete Address (house number,city and postcode etc required)*

NMC Pin Number*

Email Address*

NMC Expiry Date*

DBS/CRB Certificate Number

DBS/CRB Date of Disclosure

Date Checked of DBS/CRB Certificate Number

National Insurance Number*

Do you Have permission to work in UK?*

Current Immigration Status*

Employment

Are you currently employed?*

Position*

Work Address*

Availability

Full time availability*

Part Time Availability*

Day Shift*

Night Shift Availability*

Week Days Availability*

Are You Available on Weekends*

Starting Date

Access To Work

Can You Drive*

Own Transport*

Preferred area to Work in*

Qualification

School/college/Uinversity*

Certificate/Diploma/Degree*

From (Format: mm/yyyy)

To (Format: mm/yyyy)

Currently Doing
Present

Employment History

Name

Position Held

Address

Start Date(Format: mm/yyyy)

Character Reference

Name*

Relationship to you*

Address*

Email*

Telephone Number*

Employment Reference

Name*

Relationship to you*

Address*

Email*

Telephone Number*

Vaccinations

Tuberculosis*

Polio*

Tetanus*

Typhoid*

Rubella*

Hepatits B*

COVID 19 First Dose*

Date*

COVID 19 Second Dose*

Date*

COVID 19 Booster Dose*

Date*

Health

Surgery/Operations*

Details*

Heart Disease/Problems*

Details*

Epilepsy/Fits*

Details*

Arthritis*

Details*

Diabetes*

Details*

Joint Pain*

Details*

Varicose Veins*

Details*

Vertigo Dizziness*

Details*

Hernia*

Details*

Back Problem*

Details*

Asthma*

Details*

Alcolhol drug Dependency*

Details*

Hearing Defect*

Details*

Eczema*

Details*

Skin Problem*

Details*

Serious Accidents*

Details*

Cancer*

Details*

High Blood Pressure*

Details*

Kidney*

Details*

Have you had 2 weeks or more absence in the past 12 months?*

Details*

Have you had more than three spells of absence in the past 12 months?*

Details*

Have you been or recived any treatment from A & E of a Hospital in the past 12 months?*

Details*

Do you smoke?*

Details*

Do you drink?*

Details*

Is there any other medical condition you are currently being treated for?*

Details*

Safeguarding

Equality Act 2010
The Rans Care Limited aims to promote an equality of opportunity to all by treating all applicants fairly regardless of their ethnicity, disability, age, gender or gender re-assignment, religion or beliefs, sexual orientation, marriage or civil partnerships, pregnancy and maternity.

Do you have any disability or impairment?*

Asylum and Immigration Act 1996

Under the 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; 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 1996 is not being contravened.

Are you eligibile to work in the UK?*

Rehabilitation of Offenders Act 1974

The Rans Care Limited does not discriminate against applicants unfairly on the basis of a criminal conviction or any other information declared. Answering 'Yes' will not necessarily prevent your employment. The answer will only affect the decision depending on the information you provide in respect of the nature and the particular circumstances. Do you have any current UNSPENT police cautions, reprimands or final warning in the United Kingdom or any other country?

Do You have any current UNSPENT police cautions,reprimands or final warning in the United Kingdom or
any other country?*

Are you currently bound over or do you have any current UNSPENT convections that have been issued by
a court or court Martial in the United Kingdom or any other country?*

Privacy

Rans Care Limited only collects data for specified, explicit and legitimate use in relation to the recruitment process. By signing this application form, you consent Rans Care Limited to hold the information contained this application form. in Please be assured that your data will be securely stored by the Rans Care Limited and will only be used for the purposes of the recruitment process. If you would like to discuss this further or withdraw your consent at any time, please contact us.

Email: [email protected]
Telephone Number: 07445707252/07440011165

Declaration

The information in this application is true and complete. I agree that any deliberate omission, falsification or misrepresentation in this application form will be ground for rejecting this application or subsequent dismissal if employed by Rans Care Limited. I consent that Rans Care Limited can seek clarification regarding the professional registration details, where applicable

Name*

Date*

Signature*

By Registering, I agree to the terms

Employment Application Form

Personal Details

Employment

Availability

Access To Work

Qualification

Employment History

Character Reference

Employment Reference

Vaccinations

Health

Safeguarding

Asylum and Immigration Act 1996

Rehabilitation of Offenders Act 1974

Privacy

Declaration

Compnay Overview

Apply For Job

Our Support

Working Day/Hours