Vchc uk

- You will need two professional references to enter further in this form. It is essential that you have had professional dealings with both of your references within the last 2 years. - Remember to keep all your needful documents handy to attached at the end, before proceeding for this form. - Documents like Passport, Education, Experience, Covid Vaccination Certificate, Other Helpful Certificates to strengthen your Application related to Care Home Work. - Only JPG, PDF , PNG files are allowed to upload.

Position applied for: *

Title: *

First Name: *

Address: *

Last Name: *

Town/City: *

Nationality: *

County: *

Date of Birth: *

Postcode: *

Email: *

Date moved to this address: *

Tel Mobile: *

Tel Home:

Gender: *

Male Female

How did you hear about us: *

Current Work Status

Current Work Status: *

Self Employed or PAYE:

Self Employed PAYE None

Driving License:

Yes No

Car Owner:

Yes No

Do you have a vehicle to use?:

Yes No

Do you have Business insurance?:

Yes No

CAREER HISTORY

Please confirm your career history details for the last 10 years. Please list most recent first.

Employer:

Address:

Phone number:

Date started:

Date left:

Job title:

Full or part time:

Main duties:

Reporting to:

Reason for leaving:

Add Career History

QUALIFICATIONS & TRAINING

Please give details of training undertaken and qualifications obtained:

Training	Qualification obtained	Date	Certificate?

You should supply any certificates such as NVQ or Diplomas etc.

Have you ever suffered from any of the following:

If you have answered yes to any of the above questions please give details below:

Have you been vaccinated against Covid -19?

Injection 1:

Injection 2:

Injection 3:

Injection 4:

If no, please explain why?:

REFERENCES

The Consultancy requires 2 professional references.

It is essential that you have had professional dealings with both of your references within the last 2 years.

Name Of Referee: *

Place of Work: *

Position: *

Postcode: *

Work Address:

Country: *

Telephone Number: *

Mobile Phone: *

Email: *

Name Of Referee: *

Place of Work: *

Position: *

Postcode: *

Work Address:

Country: *

Telephone Number: *

Mobile Phone: *

Email: *

DISCLOSURES

Rehabilitation of Offenders Act

Due to the nature of the work for which you are applying, this post is exempt from the provisions of section 4.2of the rehabilitations of offender’s act 1974 (exemption order 1975). Applicants are therefore, not entitled towithhold information about convictions which for other purposes are ‘spent’ under the provisions of the act andin the event of employment. Failure to disclose such convictions could result in dismissal or disciplinary action. Any information given will be completely confidential and will be considered only in relation to an application forpositions in which the order applies and should be entered at the end of any particulars you give in support ofyour application.

A copy of our written policies is available upon request. A criminal record will not necessary be a bar toobtaining a position.

Have you ever been convicted of a criminal offence?:

Yes No

Do you have any spent or unspent criminal convictions or cautions?:

Yes No

With an enhanced disclosure, under section 4.2 of the rehabilitation of offenders act 1974 (exemption order),all previous cautions, warnings and convictions will always be detailed regardless of how long ago

Any conviction, caution, reprimand will require a written statement of each and every event and how it doesnot affect your suitability for the role you are applying for.

Have you supplied additional information with this application for any spent/ unspent convictions, cautionsor reprimands?:

Yes No

Have you ever been involved in court proceedings?:

Yes No

DECLARATION

I confirm that the information I have provided in support of this application is complete and true and , that knowingly to make a false statement could be a criminal offence.

Signature:

Date:

GDPR

The information shall be used and referred for purposes of knowing, understanding, and validating the information in relation to the qualifications for which the applicant is applying for purposes of recruitment and if successfully recruited, for information keeping and administration of employment with the Human Relations Department of the Company.

The Company shall treat all personal information with the utmost confidentiality in line with the standards of data protection required by the EU General Data Protection Regulation (GDPR).

I consent to the consultancy checking the details I have provided against the various data sources in order to verify my identity and process the application. These details may be recorded and used to assist for identity verification purposes such as the CRB, regulatory bodies such as NMC or GSCC.

I agree that all the information collected in this form is necessary, the gathering information about me, as the applicant for the job and for the position that I am applying for.

I agree I Disagree

Signature:

Date:

Consultancy Ltd retains the right to hold this application and any other data required to process this application (whether in the UK, European Union or elsewhere) and keep for as long as necessary in line with the data protection act.

Your Total Uploaded File Size(s): 0 MB

Total Remaining Limit To Upload More Files: 0 MB

Heart/Circulatory Illness/Hypertension	Yes	No
Diabetes	Yes	No
Asthma/Hay fever	Yes	No
Bronchitis/Pneumonia/Pleurisy	Yes	No
Epilepsy	Yes	No
Headaches/Migraine	Yes	No
Tuberculosis	Yes	No
Psychiatric Illness/Anxiety/Depression	Yes	No
Dermatitis/Psoriasis/Eczema	Yes	No
Back problems	Yes	No
Recurrent infections	Yes	No
Hepatitis/Jaundice	Yes	No
Are you taking any prescription drugs?	Yes	No