FirstCare Application form

    PERSONAL INFORMATION

    EXPERIENCE AND QUALIFICATIONS

    To enable us to place you, please tick what experience you have

    EDUCATION

    NEXT

    WORK EXPERIENCE

    WORK PREFERENCES

    TRAINING

    Record of Immunisations
    Please specify if you have had these immunisations and date/result

    DECLARATION OF HEALTH

    Rehabilitation of Offenders Act 1974 and Criminal Records

    By virtue of the Rehabilitation of Offenders Act 1974 (exceptions) (amendments) order 1986, the provision of a section 4.2 of the Rehabilitation of Offenders Act 1974 do not apply to any employment which is concerned with the provision of health services and which is of such kind to enable the holder to have access to persons in receipt of such services in the course of his/her normal duties.  You should therefore list all offences on a separate sheet even if you believe them to be “spent” or “out of date” for some other reason.
    CRB. The Criminal Records Bureau is the executive agency of the home office responsible for conducting checks on criminal records.  We are a registered body for receipt of CRB disclosure information.  NHS Trust and Private Sector hospitals and nursing homes insist on agencies making informed recruitment decisions, which require criminal record checks to be made on all staff.  It is a condition of proceeding with your application hat you apply for a CRB disclosure (or that you produce an acceptable original disclosure which you have already obtained). The Disclosure will be compared with the information given above and any inconsistencies could invalidate your application or lead to the cancellation of your registration with us.


    Working Time Directives

    The European Union has laid down guidelines for all workers, governing the length of maximum working week that is safe to work.  The current limit is 48 hours per week.  Because you are under no obligation to accept work offered, you will never be compelled to work more than 48 hours per week but you may choose to do so.

    Please would you sign below to confirm that you have read and understood this information, indicating your preference by ticking the most appropriate statement

    Data Protection Act 1998 and Inspection

    Part of the care standards commission inspection process involves checking that we maintain certain information on staff e.g. address, qualifications, a mechanism for checking health and fitness including records of immunisation, record of training, annual leave and sickness, two written references and rehabilitation or Offenders information.  Inspectors will need to know that the company in maintaining the information as we should; please be assured that they will not wish to read personal information such as supervision notes.

    We would be grateful if you would complete and sign the declaration below.  If you have any concerns about this or want to discuss it further, please contact FirstCare (GB) Ltd.

    References

    Please give the names of two professional people or senior/grade position to you, including your present or most recent employer whom we may approach for a nursing reference (not relatives or friends).  They must be able t provide a credible comment on your ability to undertake the duties of the post applied for.

    Home addresses of referees are not acceptable.

    DECLARATION

    The information that I have given in this registration form is to the best of my knowledge, complete and accurate in all respects.  I understand that knowingly giving false information will disqualify me from registration with this agency.  I also agree to keep FirstCare (GB) advised of any changes to any information
    Please ensure you supply original and photocopies of the following:

    Two passport sized photographs                                                                                  ٱ

    Proof of identity (birth/marriage cert. New style driving licence/passport)                   ٱ

    Copy of work permit, visa stamp, entry stamp (overseas applicants)               ٱ

    Completed Equal Opportunities form                                                              ٱ

    Relevant certificate of training                                                                         ٱ

    Proof of National Insurance Number

    Copy of Driving License (if applying as a driver)                                                                    ٱ