Full Name

Email Address *

Phone Number *

Date of Birth *

Nationality

Please upload copies of your Right to work in the UK *

N.I Number

Please Upload Proof of N.I *

What Role are you applying for ?
Healthcare Support WorkCare AssistantNursingHomecare

Do you have a Current DBS?
YesNo

Please attach copy of DBS

Please Capture Photo for your ID Badge

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Please upload two proof of address *

Bank Statements, Drivers license, Council tax or any recent utility bill

Name

Address

City

Phone Number

Postcode

Preferred Start Date

Do you have any experience working with the following

Residential HomeSupported Living PlacementNursing HomeCommunity Care

Upload Resume *

Upload Copies of Training Certificates

PIN number

Date of Registration

Upload Confirmation of NMC registration.

Preferred Shifts Shift Times

EarliesLate ShiftsLong DaysNights

References

(We can only accept work references from your Direct Line Manager not work colleagues. Please use work contact details only ensuring one reference is from your current or most recent employer. We do not accept personal references)

Full Name

Email*

Phone Number

Company name

Full Name

Email*

Phone Number

Company name

Name of Bank

Name of Account

Account Number

Sort -Code

I Authorised Equity staffing limited to pay my wages into the above account
YesNo

Do you have any health issues or disabilities that will be prevent you from carrying out your duties as a Healthcare Professional to a satisfactory standard?

YesNo

Do you have any spent or unspent conviction?

In view of the nature of the work for which you are applying, this post is exempt from the provision of 2.4(2) of the Rehabilitation of Offender Act 1974 by virtue of the Rehabilitation of Offenders Act (Exceptions) Order 1975. Applicant are, therefore, not entitled to withhold information about convictions, which for other purposes are “spent” under the provision of the Act and, in the event of employment, any failure to disclose such convictions would result in dismissal. Any information given will be completely confidential and will be considered only in relation to this application.

YesNo

Code of Confidentiality

You automatically accept our code of confidentiality when you register with Equity Staffing Ltd.

In the course of your duties you may have access to confidential information about patients / clients. On no account must information relating to identifiable clients be divulged to anyone but your branch managers or his / her assistant.

You should not disclose ANY information to your family, friends or neighbors.

If you are worried by any information you have obtained and wish to discuss it, please make an appointment to speak in private to your branch manager.

Failure to observe these rules will be regarded as serious misconduct, which could result in your removal from the Equity Staffing Ltd register.

I have read and understood the Equity Staffing Ltd code of confidentiality and agree to abide by its contents.

General Data Protection Regulations

The personal details contained in this application form, and any additional personal information contained in any other documents supplied to us with your application will be retained and processed by EQUITY STAFFING LTD as data controller, and may be passed to necessary authorities and employers as required to enable you to work as an agency worker with us. In proceeding with your application with us and during and following your employment, you consent to our processing and use of such information.

Equal Opportunities

Equity Staffing Ltd is fully committed to the principle of Equal Opportunities in recruitment irrespective of color, race, sex, marital status, sexual orientation, ethnic origin, nationality, religion, disability or age.

Declaration

By signing this application, I declare that all information given by me is accurate and in no way misleading or false.

Upload Signature