Job Application Form – Instant Healthcare UK | Specialist Recruitment Agency

UK INSTANT SERVICES LTD

Select Job Type *

Post Number: *

Application for Employment

Closing Date:

Interview Date:

THE INFORMATION YOU SUPPLY ON THIS FORM WILL BE TREATED IN CONFIDENCE.

Section 1 Personal Details

Name: *

First

Last

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Date of Birth *

Home Telephone No: *

Daytime Telephone No: *

Mobile Telephone No: *

National Insurance No:

Email Address: *

Attach your CV

Click or drag a file to this area to upload.

Can we contact you at work? *

Are you free and take up employment in the UK with no current immigration restrictions? *

Job Share Details

Are you apply in a job share basis? *

Driving License – if relevant to post applied for.

Do you hold a full,clean driving license valid in the UK? *

Does your license include C1 Category? *

If you are successful you will be required to provide relevant evidence of the above details prior to your appointment.

Section 2 Present Employment

Name of Employer: *

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Post Title: *

Date of Appointment: *

Salary *

Department/ Section: *

Brief Description of duties: *

Period of notice: *

Last day of service (if no longer employed): *

Reason for leaving (if no longer employed): *

Did you receive any redundancy payment or retirement benefit? *

Section 3 Previous Employment

Previous Employment (most recent employer first). Please cover the last 10 years and state nature of business - if not public sector

Name of Employer: *

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Position Held: *

From:

To:

Summary of duties: *

Reason for leaving: *

Name of Employer: *

Address : *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Position Held: *

From:

To:

Summary of duties: *

Reason for leaving: *

Name of Employer: *

Address : *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Position Held: *

From:

To:

Summary of duties: *

Reason for leaving: *

Section 4 Education

Qualifications obtained from Schools, Colleges and Universities. Please list highest qualification first:

College or University *

Course *

Qualifications and grades obtained *

School *

Subjects *

Qualifications and grades obtained *

Professional, Technical or Management Qualifications

Please give details:

Professional, Technical or Management Qualifications *

Course Details *

Membership of any Professional / Technical Associations- Please state level of Membership: *

Section 5 Training and Development

Please give details of any training and development courses or non-qualifications courses which support your Application. Include any on the job training as well as formal courses.

Title of Training Programme or Course *

Duration of Course *

Section 6 Personal Statement

Abilities, skills, knowledge and experience.

Please use this section to explain in detail how you meet the requirements of the Employee profile.If you or have been involved in voluntary/unpaid activities ,please also include these information.Attach and label any additional sheets used.

Paragraph Text

Section 7 Rehabilitation of Offenders Act (1974)

The post you are applying for, unless otherwise stated, is exempt from Section 4(2) of the Rehabilitation of Offenders Act 1974 by virtue of the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975. You are therefore, required to disclose here any convictions (including ‘spent’ convictions) for criminal offences brought against you and any pending court action.

Have you at ANY time been convicted of an offence, spent or unspent? *

If yes, please give details / dates of offence(s) and sentence:

Section 8 Protecting Children and Vulnerable Adults (1974)

The following information may be required if the post you are applying for has a requirement for a Criminal Records Bureau police check.

Enhanced Checks

Are you aware of any police enquires undertaken following allegations made against you, which may have a bearing on your suitability for this post? *

Section 9 Disability Discrimination Act

This Act protects people with disabilities from unlawful discrimination. We actively encourage applications from people with disabilities. The Disability Discrimination Act defines a disabled person as someone who has a physical or mental impairment which has a substantial and adverse long term effect on his or her ability to carry out normal day to day activities.

Do you have a disability which is relevant to your application? *

If yes, please give details:

We will try to provide access, equipment or other practical support to ensure that people with disabilities can compete on equal terms with non-disabled people.

Do we need to make any specific arrangements in order for you to attend the interview? *

If yes, please give details :

Section 10 Health

Successful applicants will be required to complete a detailed medical questionnaire and may be required to attend a medical examination prior to being appointed.

Number of days sickness absence in the last 2 years: *

Please state number of occasions in the last 2 years: *

Section 11 References

Please give the names and addresses of four referees (two of which MUST be your most recent employers). If you are unable to do this, please clearly outline who your referees are. Reference 3 & 4 will only be used should we be unable to contact references 1 or 2.

Reference 1

Reference 2

Name: *

Name *

Position (job title): *

Work Relationship: *

Organisation *

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Telephone No: *

Email *

Are you willing for this referee to be approached prior to the interview? *

Reference 3

Reference 4

Name:

Position (job title):

Work Relationship:

Organisation:

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Telephone No:

Email:

Are you willing for this referee to be approached prior to the interview?

Section 12 employment Monitoring Form

This sheet will be separated from your application form upon receipt and does not form part of the selection process. It will be retained by the Human Resources purely for monitoring purposes.

Application for the post of: *

Instant Healthcare UK wants to ensure that all applicants are treated equally whatever their race, colour or ethnic origin. To do this we need to know about the ethnic origin of people who apply to join us. These categories were used in the 2011 Census and are listed alphabetically. Which groups do you most identify with?

Please mark ‘X’ in only ONE box in column A and only ONE box in column B

COLUMN A

COLUMN B

British or Mixed British
English
Irish
Scottish
Welsh
Any other? (please specify)

ASIAN

Bangladeshi
Indian
Pakistani
Any other Asian background (please specify)

BLACK

African
Caribbean
Any other Asian background (please specify)

CHINESE

Any other Asian background (please specify)

MIXED ETHNIC BACKGROUND

Asian and White
Black African and White
Any other Asian background (please specify)

WHITE

Any other Asian background (please specify)

ANY OTHER ETHNIC BACKGROUND

Any other Asian background (please specify)

Section 12 employment Monitoring Form continued

Gender *

Male