If you are applying for a position as a registered nurse
How will you get to work if offered the post?
Reason for applying for this post and please state why you believe that you are suitable for this position:
When are you available to start work?
Because of the nature of the work involved , the position you are applying for is exempt from the provisions of Section 4(2) of the Criminal Offenders Act 1974 (exceptions) Order 1975. You are therefore not entitled to withhold information about convictions which for other purposes as "spent" under the provisions of the Act. In the event that your services as an employee are retained by Amna Care Domiciliary, any failure to disclose such convicrtions, however long ago they occurred, could result in termination by the Company. Any information given will be completely confidential and will be considered only in relation to an application for positions to which the Order applies.
Do you have any convictions to disclose?
If Yes, please provide full details about the date of the conviction(s) and the offence(s) involved
Do you have permission to work in the UK?
Do you require a Work Permit?
Are you an Overseas Student?
I confirm, to the best of my knowledge, I am clear from MRSA at present. Should I come into any contact or have any suspicion that I have come into contact with MRSA, I will inform Amna care domiciliary ltd immediately.
Please provide the name and address of two people who will provide a reference for you. We would prefer one to be your current employer, but if this is not convenient for you, you may give the details of your previous employer. Relatives or colleagues cannot be used as a reference.
The information that you provide on this form and give at Interview will be used by Amna Care and domiciliary Ltd to provide you with suitable work opportunities. In completing this form, you agree to your information being added to our database and consent to us transferring your personal details to our Clients. We may also use or pass this information to certain third parties to detect crime, to protect public funds, or any other way permitted by law.