Apply - Taks Healthcare LTD

Personal Details

First Name

Last Name

Other Names

Title

Sex

Date of Birth

N.I. Number

Do you Drive

Full Address

Post Code

Telephone

Mobile

Nationality

Do you require Work Permit

Type of Permit

Proffesional Registrations

NMC/HCPC Pin or Registration

Registration Date

Part Of Register

Expiry

Insurance Number

DBS Ref Number

Date Applied

Date Received

Notes

Educational Qualifications

Date

Course 1

Qualification 1

Institution 1

Grade 1

Date

Course 2

Qualification 2

Institution 2

Grade 2

Date

Course 3

Qualification 3

Institution 3

Grade 3

Enter Date

Course 4

Qualification 4

Institution 4

Grade 4

Enter Date

Course 7

Qualification 5

Institution 3

Grade 5

Enter Date

Course 6

Qualification 6

Institution

Grade 6

Enter Date

Course 7

Qualification 7

Institution 7

Grade 7

Other Courses

Previous Employment & Reference Details

CONVICTIONS
Please list allconvictions Details
Have you ever been fined, imprisoned, placed on probation, discharged on payment of costs or any order against you by a criminal, civil or military court or public authority? (Exclude minor motoring offences).

Have you had any alleged offences outstanding against you?.

Outstanding convictions

Have you had any alleged offences outstanding against you?.

Details of offences

Please give details of all bankruptcy and court judgements:

bankruptcy and court judgements

PROFFESIONAL CHARACTER REFERENCE
Previous Employment & Reference Details
Please give details of two or more people who have known you for a minimum of two years. These must not be relatives (by blood or marriage) and anyone residing with you (Note some jobs require 5years references) At least one must be your someone you worked under and for a similar position or type of work you are applying for.

Character Reference Details

Name

Company Name

Phone

Occupation

Address

Period Known

Relationship

Character Reference Details

Name

Company address

Phone

Occupation

Address

Period Known

Relationship

Character Reference Details

Name

Company Name

Phone

Occupation

Address

Perion Known

contact phone

Character Reference Details

Name

Company Name

Phone

Occupation

Address

Period Known

Relationship

Employment History
Previous Employment & Reference Details: Please provide your employment history backdating 10 years starting with the most recent. Give details of any unemployment period, giving your benefits office you report or reported to :

Reference 1

Start Date

End Date

Employer

Employer email

Reason for leaving

Address

Name of Employer

Position

Wage

Reference 2

Start Date

End Date

Employer

Employer Email

Reason for leaving

Address

Name of employer

Position

Wage

Reference 3

Start Date

End Date

EmployerEmail

Employer

Reason for leaving

Address

Name of Employer

Position

Wage

Reference 4

Start Date

End Date

EmployerEmail

Employer

Reason for leaving

Address

Name of Employer

Position

Wage

Upload Official ID
Previous Employment & Reference Details
Please upload your official ID, Proof of address: Utility bill (must be less than 3months), and Passport Photos

Official ID

DECLARATION
SUBMITTING THIS FORM MEANS YOU AGREE WITH THE STATEMENT BELOW
I declare that all the information given herewith is correct and may be verified where necessary. Failure to make declaration nof relevant information may be interpreted as making false statement and misleading and may lead to immediate dismissal and also constitute as a criminal offence.

Confidentiality Declaration:
Registration implies acceptance of our code of confidentiality. In the course of your duties you may have access to confidential information about your clients. On no account must information relating to identifiable client be divulged to anyone other than the manager of the agency. You should not disclose ANY information to your family, friends or neighbours. If you are worried of any information you have obtained and consider that you should talk about it to someone else , you must call the office and speak to the manager. Failure to observe these rules will be regarded as serious misconduct which could result in removal from the agency register.

Data Protection Statement:
The personal information (data) collected on this form, and on the attachments, (which includes the collection of sensitive personal data) are collected for the purposes of recruitment, personnel administration (for new employees) and monitoring. Unless you direct otherwise (for example in a situation where you would like this Application kept on file for future vacancies) the Application Forms (and attachments) of unsuccessful applicants will be destroyed after 6 months. It is the policy of the Agency to protect, and keep secure, all personal data collected. All personal data is processed for the purposes of recruitment, and, in the case of successful Applicants, for the satisfactory administration of their employment, and for no other purpose.

The personal information (data) collected on this form, and on the attachments, (which includes the collection of sensitive personal data) are collected for the purposes of recruitment, personnel administration (for new employees) and monitoring. Unless you direct otherwise (for example in a situation where you would like this Application kept on file for future vacancies) the Application Forms (and attachments) of unsuccessful applicants will be destroyed after 6 months. It is the policy of the Agency to protect, and keep secure, all personal data collected. All personal data is processed for the purposes of recruitment, and, in the case of successful Applicants, for the satisfactory administration of their employment, and for no other purpose.

Equality of Opportunity Statement:
The Agency’s Equal Opportunities Policy covers all employees, or potential employees, and embraces the principle that all people shall be treated equally, regardless of their age, gender, ethnic origin, nationality, colour, religion, marital status, sexual orientation, religion or belief, disability, or offending background.

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