Registered Nurse - Balhousie Care Group

1/8 Personal Details

Name*

Postal Address*

Street Address Address Line 2 City ZIP / Postal Code

Home Telephone

Mobile Telephone*

Email Address*

Date of Birth*

Do you have a right to live and work in the UK and if appointed would you be able to produce acceptable documentation?*

Yes
No

Preferred Hours of work/shift patterns?

Detail days and hours

Current Rate of Pay*

(e.g £10 per hour)

Desired Rate of Pay*

(e.g £10 per hour)

NMC Pin Number

Where applicable

NMC Pin Expiry Date

Do you have a current UK Driving Licence?

Yes
No

If YES, do you have any endorsements or penalty points?

Yes
No

Do you have your own transport for commuting to and from work?

Yes
No

Please provide additional relevant information

2/8 Education

Relevant qualifications e.g School / College / University / Adult Education / VQ / Assessors etc Please begin with most recent and work backwards

Education #1: Qualification Achieved & Grades

Education #1: Name & Address of Education Establishment

Education #1: Date From & To

Education #2: Qualification Achieved & Grades

Education #2: Name & Address of Education Establishment

Education #2: Date From & To

Education #3: Qualification Achieved & Grades

Education #3: Name & Address of Education Establishment

Education #3: Date From & To

Other Training / Courses

3/8 Employment History

Current or Most Recent Posts

Employment #1: Employer Name, Address & Nature of Business*

Employment #1: Job Title*

Employment #1: Main Duties / Responsibilities*

Employment #1: Reason for leaving*

Employment #1: Dates From & To*

Employment #2: Employer Name, Address & Nature of Business

Employment #2: Job Title

Employment #2: Main Duties / Responsibilities

Employment #2: Reason for leaving

Employment #2: Dates From & To

Employment #3: Employer Name, Address & Nature of Business

Employment #3: Job Title

Employment #3: Main Duties / Responsibilities

Employment #3: Reason for leaving

Employment #3: Dates From & To

Any additional positions that are relevant to your application?

4/8 References

Please provide details of two referees.

First reference must be from your current employer (or most recent employer, if you are unemployed). Second reference must be from a previous employer (unless you have held only one job, in which case this may be an educational or character reference).

If you have never held a job, educational and/or character references will be satisfactory. A character referee: must have known you well personally for at least two years; must not be related to you by birth or marriage; and must hold (currently or retired) some form of professional occupation or public office. If you are applying for a nursing position, please provide details of two referees at Charge Nurse level or above.

1st Referee

Referee Role

Employment
Educational
Character

Name

Capacity in which known to you

Job Title / Position

Address

Street Address Address Line 2 City ZIP / Postal Code

Email Address

Telephone Number

2nd Referee

Referee Role

Employment
Educational
Character

Name

Capacity in which known to you

Job Title / Position

Address

Street Address Address Line 2 City ZIP / Postal Code

Email Address

Telephone Number

5/8 Rehabilitation of Offenders Act

In order to protect the public, the post you have applied for is exempt from certain provisions of the Rehabilitation of Offenders Act 1974. You are therefore required to disclose ALL AND ANY past or pending charges / convictions, WHETHER SPENT OR OTHERWISE. All information provided will be kept in the strictest confidence and only used for the purpose of assessing your suitability for the post you have applied for.

Rehabilitation of Offenders Act

Where did you learn about this vacancy? (Please be as specific as possible)

If it was an existing Balhousie employee, please let us know their name and where they work, Thanks.

6/8 Covid-19 Vaccine

We consider that it is the professional responsibility of all of our staff to be fully vaccinated against COVID-19 in order to safeguard both our employees and Service Users, therefore our preference is that you are fully vaccinated.

7/8 Statement in Support of Application

What do you believe equips you for the position(s) you are applying for?*

8/8 Declaration

I confirm that the information provided on this Application Form is, to the best of my knowledge, true and accurate. I understand that any employment offered may be immediately terminated if any of the information is found to be misleading or untrue. I agree that Balhousie Care Group may contact any or all of my former employers (where applicable) if necessary in order to obtain an employment reference.

As part of any recruitment process, Balhousie Care Group collects and processes personal data relating to job applicants. We are committed to being transparent about how we collect and use that data and to meeting our data protection obligations. To find out more about how we collect, store and use your data, please consult our privacy policy on our website here. By signing below you are giving permission for Balhousie Care Group to process your data in line with our secure recruitment processes.

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