FourtuneHealthcare

Applications

Fourtune Healthcare Services Ltd

07464978498

Email: [email protected]

www.fourtunehealthcare.com

Job application form

Job Role:

Preferred Area:

1. Personal details

First name:

Last name:

Current Address :

Duration: From: To:

Previous Address:

Duration: From: To:

Add Address:

Home Telephone No.:

Daytime Contact No.:

E-mail address :

Date Of Birth:

place of birth as per Passport:

Country of birth:

Date arrived in the UK:

UTR NO :

Immigration Status/ Work Permit Given :

Immigration issue date :

Immigration expiry date :

Employee/ bank account holders name :

Bank Name :

Bank Sort Code :

Bank Acct No :

Building Soc Roll No :

National Insurance No. :

Driving License :

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

Yes No

Do you have right work in the UK ?.

Yes No

2. Preferred hours

Please tick

Full-time Part-time

3. Education/Qualifications

	Qualification	Date obtained	Grade

Do you have any naursing qualification ?.

Yes No

4. Employment history

Previous employment: Please include any previous experience (paid or unpaid), starting with the most recent first.

Current or most recent employer

Name of employer:

Address :

Position held :

Date started :

Leaving date:

Contact details of line manager for reference:

Brief description of duties:

you are a registered nurse ?.

Yes No

6. Convictions/ Disqualifications

Rehabilitation of Offenders Act 1974 (Exceptions)(Amendment) Order 1986 We would draw your attention to the following statement: -

“Because of the nature of the work for which you are applying, this post is exempt from the provisions of Section 4(2) of the Rehabilitation of Offenders Act, 1974, by virtue of the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975 and the Rehabilitation of Offenders Act 1974 (Exceptions) (Amendment) Order 1986. Applicants are, therefore, not entitled to withhold information about convictions which for other purposes are ‘spent’ under the provisions of the Act”.

Please provide details below if you have been convicted of a criminal offence or been the subject of a conditional discharge or probation order. (Past criminal proceedings are not necessarily an obstacle to taking up a post. This occurs only where the offence/s is/are deemed relevant. Any details will be discussed with you should you be the successful candidate based on your supporting statement, interview and tests).
A criminal record will not necessarily be a bar to obtaining a position. If a check is returned and reveals any information, this will be discussed with the applicant

7. Reasonable adjustments/Arrangements for interview

Please contact us if you need the application form in an alternative format including large print.

Are you subject to any conditions relating to your employment inthis country?.

Yes No

If "yes" please use the space below to tell us what these are?

If you need us to make any adaptations for your interview to accommodate any disability you may have please tell us what these should be

Start Date :

Notice Period :

References

Please give the detail of two references – see guidance sheet for further information

Current Employer :

Address :

Post Code

Tel:

Name :

Address :

Post Code

Tel:

Supporting Documents

PDF List

DBS

Both side of BRP card

Passport Coppy

Utility Bill

Declaration

Statement to be signed by the applicant

Please complete the following declaration and sign it in the appropriate place below. If this declaration is not completed and signed, your application will not be considered.

I agree that Fourtune Healthcare Services Ltd can create and maintain computer and paper records of my personal data and that this will be processed and stored in accordance with the Data Protection Act 1998.

I confirm that all the information given by me on this form is correct and accurate and I understand that if any of the information I have provided is later found to be false or misleading, any offer of employment may be withdrawn, or employment terminated.

Name:

Date:

Minimum five years of address is required.

Applications

Please complete the following declaration and sign it in the appropriate place below. If this declaration is not completed and signed, your application will not be considered.

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