Application For A Nurse Job Form

Personal Data

Title (Mr / Ms / Dr / Prof)

Full Name

Gender

Date of birth

Email Address

Phone

Next of Kin Address:

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Country

NI Number

Job Title

Emergency Contact

Full Name

Emergency Contact Phone

Their Relationship to you

Right to work

Are you legally eligible to work in the UK?YesNo

Are you required to have a UK work visa / permit?YesNo

Professional registration (if applicable)

Issuing body

Have you ever been investigated, removed, or suspended by a professional body?YesNo

Rehabilitation of Offenders Act

Have you ever been convicted, cautioned, reprimanded, or given a final warning for a criminal offence?YesNo

Are you waiting to hear about any prosecutions pending?YesNo

Have you ever been the subject of a disciplinary investigation or proceedings by a previous employer in any position you have held?YesNo

Are you aware of any police enquiries undertaken following allegations made against you, which may have a bearing on your suitability?YesNo

Consent

I consent to 3rd party audit checks?YesNo

I consent for Bridgelightplus to apply for a DBS, for DBS update service checks and retention of a copy of my DBS certificateYesNo

I consent for my personal data to be supplied to your preferred umbrella company (if applicable)YesNo

I consent to approach referencesYesNo

I consent to Right to Work checksYesNo

I consent to Professional Regulatory Body checksYesNo

I consent for Bridgelightplus to provide copies of my CV, DBS and references to any prospective employer for the purposes of securing workYesNo

I will only accept roles relevant to my skills and experience. I will express interest in roles where I believe my skills are transferable but understand that this decision will lie with the client as to whether I am eligible for appointment.YesNo

References

References 1

Full Name

Position

Organization

Email Address

Phone Number

Start Date

End Date

References 2

Full Name

Position

Organization

Email Address

Phone Number

Start Date

End Date

References 3

Full Name

Position

Organization

Email Address

Phone Number

Start Date

End Date

EDUCATION

School/College/University

Examinations Passed/Qualifications gained

Please supply copies of certificates

TRAINING HISTORY/PROFESSIONAL STATUS

Date of Graduation/Qualification

Location/Details

Notes

Please supply copies of certificates

EMPLOYMENT HISTORY Current/ most recent first. Information must cover the whole of your working life to date. State the reasons for any breaks in employment. Use a separate attached sheet if required; please sign that sheet(s).

Date employed:

Nature of business:

Position held and reason for leaving:

Salary / Rate:

File

Decleration

WTR

The WTR place a limit on the average number of hours per week that can be worked. If you are prepared to work more than the stipulated average hours per week (48 hrs) and therefore opt out of the WTR agreement, please select 'YES' below.YesNo

GDPR

I accept the terms outlined in the Privacy Policy.YesNo

In order to provide you with recruitment, payroll and related services we need to acquire and retain certain information about you as an individual. We will keep this information securely, only using it for the purposes outlined in our Privacy Policy, and in full compliance with the prevailing data protection legislation. Where necessary, in order for us to complete our service to you – such as ensuring you’re paid for the work you do – we will securely pass your personal information to approved third party service providers, such as payroll agencies. We only work with other businesses that are GDPR compliant, so you can rest assured your personal information is safe and secure. You must agree to our Privacy Policy in order for us to work with you.

I agree to receive selected marketing communications from Bridgelightplus.YesNo

From time to time, we’d like to contact you to let you know more about the services we offer, share our latest career-related blog articles or news, or let you know about exclusive offers and promotions. We’d like to do this via email, post, SMS, phone and other electronic means. We’ll always treat your personal information with the utmost care and will never sell them to other companies for marketing purposes. We will not SPAM you or bombard you with marketing communications. You can always opt out of receiving these marketing communications at any point in the future, as all our emails include an unsubscribe link Decleration By submitting this form, I hereby confirm that the information given is as complete as possible, true and correct and states that I am entitled to work through an agency in the UK. I agree that I will comply with all compliance procedures and ensure that all my documentation is present and correct. I understand that appointment to any position is conditional on satisfactory registration and qualification checks, and that any information disclosed on this registration form will be checked. Any offer of appointment may be withdrawn if you knowingly withhold information, or provide false or misleading information, and that registration may be terminated should any subsequent information come to light once you have been appointed. Consent

I agree to the privacy policy