Registration Form – Three Angel Healthcare LTD

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IT IS IMPORTANT THAT YOU ANSWER ALL QUESTIONS FULLY. PLEASE WRITE IN CAPITAL LETTERS ONLY. PLEASE NOTE THAT IF YOU DO NOT HEAR FROM US WITHIN 4 WEEKS OF SUBMITTING YOUR APPLICATION, YOU HAVE BEEN UNSUCCESSFUL ON THIS OCCASION.

Below is a list of documents you will need if you hear back from us:

Current passport, birth certificate if British citizen or a driving license
Two recent passport photographs
Two proofs of identification with your name and current address issued in the last three months
Documents /certificates of any relevant qualification and training to care work

- Step 1 of 6

Position Applied For *

If you are invited for an interview please bring 2 passport sized photographs, your passport/birth certificate, proof to work in the UK, and a utility bill in your name with your current address.

Name *

First

Last

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Phone *

Email *

Date of Birth *

Please Select the Age Group Which Applies to You: *

16-17
18-64
65+

Are You Eligible to Work in the UK? *

Employment History

Please provide a full employment history. List in order the organisations you have worked for, full time and part-time, paid or unpaid, including relevant voluntary work and include any periods of non-employment.

Education

Please state any relevant professional qualifications/training/membership of professional bodies with dates and levels attained. Please indicate where these are currently being continued:

Please list any training you have received or courses which did not lead to a qualification but which you feel are relevant to the post for which you are applying:

Additional Relevant Information:

Please give details of relevant experience and any other information which you consider may be helpful in assessing your suitability for the post for which you are applying.

Professional Registration Details - Nurses Only *

Yes, I am a nurse.
No, I am not a nurse.

Registration Number

Date of Registration

Registration Body

Date of Renewal

Equal Opportunities

Three Angel Healthcare is an equal opportunities employer. The sole criteria for selection is the suitability of an applicant for the job for which they are applying. We do not discriminate on any grounds. We are required by law to monitor the effectiveness of our Equal Opportunities policy and should your application be successful we will ask you to complete a confidential form. Thank you.

Health

Should your application be successful and you are made an offer, you will be asked to complete a medical screening questionnaire. The information on your medical screening questionnaire will be treated as strictly confidential. Any need for reasonable adjustments will be considered. Failure to disclose relevant information may affect your probationary review.

Convictions

Rehabilitations of Offenders Act of 1974 - Do you have any convictions or offences, information of which you are entitled to withhold, under the Rehabilitation of Offenders Act of 1974 (Exceptions) Order 1975, in view of the nature of the work for which you are applying?

Yes or No *

If yes, please give details below.

If your application is successful you will be required to provide a satisfactory Enhanced Criminal Records Bureau Disclosure. Three Angel Healthcare will offer their full support throughout this process. A copy of the CRB Code of Practice is available upon request.

References

Please give details of three referees (who should not be relatives or friends), at least on of whom should be your current of last employer relating to a period of not less than 3 months employment. If you have not worked for some time or have never worked, please give the name of someone who can comment on your ability to do the job for which you are applying. Please note that all offers of employment are conditional upon receipt of at least two satisfactory references.

References

References will only be taken after an offer of employment has been made.

Other Interests

Please give details your personal interests and hobbies.

Conflict of Interest

Do you have a close personal/family relationship with anyone currently working for Three Angel Healthcare?

Yes or No *

If yes, please give details below.

Declaration

I understand that the data l have given will be processed and used in accordance with the data protection act and hereby give permission for my details to be retained. I confirm that to the best of my knowledge and belief, the information I have given is correct. I hereby give Three Angel Healthcare permission to contact my referees and understand that any contract given to me is based on the information provided.

Agreement *

I agree to the above statement.

Signed *

Date *

151 Chatteris Avenue Romford RM3 8JY

01708532297

info@threeangelhealthcare.co.uk

CONTACT US

Name

Message

Equal Opportunities

Health

Convictions

References

Conflict of Interest

Declaration

151 Chatteris Avenue Romford RM3 8JY

01708532297

info@threeangelhealthcare.co.uk

CONTACT US

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