Job Application – ScotNursing

Application Form

Candidate Identification Number (for Office Use Only):

Application for:
Registered NurseTrained Carer

PERSONAL DETAILS

Surname

Forename

Title

Maiden Name/Previous Name(s)

Address

Postcode

Contact Telephone Number (Day)

Contact Telephone Number (Evening):

If we need to, the best way to contact you is by:
PhoneEmail

Next of Kin

Relationship

Contact Tel No

WORK PERMIT

Do you need a permit to take up this post?
YesNo

WORKING in the UK

Are you eligible to work in the UK?:
YesNo

Higher/Further Education

Place of Study	Course	Grade Acheived

Are you currently working towards a qualification? If yes, complete below:

Place of Study	NAME TYPE OF QUALIFICATION (e.g. HNCHealth Care)	Start Date	Completion Date

Membership of Professional or Regulatory Boards (e.g NMC, SSSC)

Name of Organisation	Registration For	Registration Number	Renewal Date

16-Digit PVG Membership Number:

Are you a member of a Trade Union/Professional Body?
YesNo

If “Yes”, which one?

Registration Number:

PRESENT OR MOST RECENT POST

Job Title:

Grade:

Anntrual Salary:

Date of Starting Grade:

Employer:

Date of Employment

From:

To:

Reason for Leaving (if applicable):

Role Purpose/Summary of Responsibilities:

Employement History

Start with your most recent employment first, and work down the page, providing the last ten years’ employment history. If a job supports the position applied for, please say more about it in your application statement.

Recent Job Title:	Employer:	Date From:	Date To:

Referees

Your referees will include your current (or most recent) employer. Please identify below the person in your organisation (e.g. your direct line manager) who is authorised to confirm your employment and the details given in your application. Please identify a second referee who may have closer knowledge of your skills, knowledge, and abilities, and who may offer
opinion on your suitability for the post. You should not use family members or friends. You should use referees from two separate employers. Our pre-employment screening also includes, where appropriate, health and fitness for work, criminal records, qualifications, and professional registration.

Name 1:

Designation:

Telephone:

Email:

Address:

Post Code:

Name 2:

Designation:

Telephone:

Email:

Address:

Post Code:

Disability

The Disability Discrimination Act 1995 and Amended Regulations 2005 defines disability as follows: “any physical or mental impairment which has a substantial adverse effect on a person’s ability to carry out normal day to day activities.” ScotNursing is “Positive About Disabled People”, and as such we provide job opportunities for people with disabilities people.

Please specify any special requirements if attending for interview, e.g. Induction Loop, Wheelchair Access, Signer:

Driving Licence

Do you have a current UK driving licence?
YesNo

If "Yes" for which type of vehicle?

STATEMENT IN SUPPORT OF APPLICATION – Please tell us your personal qualities and attributes, experience, and any major achievements and show how they match thoseneeded for working with us:

Immunisation

Immunisation	Certification Date	Notes
Hep B Mandatory		You will require to provide evidence of viral titre above 100.
Rubella		You will require to provide evidence of antibibodies.
Tuberculosis		You will require to provide certification of BCG Star Check or Heaf/Mantoux result of 2-4.
Varicella		You can self declare having chicken pox or shingles. If not you require to provide evidence of blood results.

Our Occupational Health team can assist with the above if required.

Bank Details for Wages

Name of Account Holder:

National Insurance No:

Name of Bank:

Address of Bank:

Postcode:

Sort Code:

Account No:

Please read the following statements. You will be asked to sign a declaration if you areappointed.

I have completed parts A to E of this application form and the details I have supplied are, to the best of my knowledge, true and complete;
I understand that, if successful, the information on this form will be kept as part of my personal file record;
I authorise you to obtain references to support this application if I am identified as a suitable candidate;
I understand that details of educational qualifications, membership of professional bodies, and referee reports may be verified through the establishments and individuals I have indicated;
I understand that the information that I provide on this form and on any CV given will be used by ScotNursing Limited to provide you work finding services. In providing this service to you, you consent to your personal data being included on a computerised database and consent to us transferring your personal details to our clients.
I understand that ScotNursing Limited may check the information collected, with third parties or with other information held by us.
I undserstand that ScotNursing Limited may also use or pass to certain third parties information to prevent or detect crime, to protect public funds, or in other way permitted or required by law.
I consent to my details being kept confidentially and used for specific and lawful purposes as specified in the Data Protection Act 1998;
I have read, understand and hereby consent to the attached “Privacy Notice” issued to me with this Application Form;
I declare that I have no previous convictions, or will identify I have on the PVG Declaration form to be completed alongside this application form.

Date:

Application Form

Candidate Identification Number (for Office Use Only):

PERSONAL DETAILS

WORK PERMIT

WORKING in the UK

Higher/Further Education

Are you currently working towards a qualification? If yes, complete below:

Membership of Professional or Regulatory Boards (e.g NMC, SSSC)

PRESENT OR MOST RECENT POST

Employement History

Referees

Disability

Driving Licence

STATEMENT IN SUPPORT OF APPLICATION – Please tell us your personal qualities and attributes, experience, and any major achievements and show how they match thoseneeded for working with us:

Immunisation

Our Occupational Health team can assist with the above if required.

Bank Details for Wages

Please read the following statements. You will be asked to sign a declaration if you areappointed.

EQUAL OPPORTUNITIES MONITORING

Do you have a physical or mental health condition or disability that:

What is your ethnic group?

Head office

Fax

Email us

Regional Offices

Aberdeen | 01224 973076

Ayr | 01292 434589

Dumfries | 01387 403429

Dundee | 01382 767419

Dunfermline | 01383 660773

Edinburgh | 0131 357 8969

Helensburgh | 01436 648 816

Inverness | 01463 214952

Perth | 01738 503270

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