Application Form

"*" indicates required fields

Vacancy Title*

Where did you hear about this vacancy?*

Personal Details

Full Name*

Title*

First Name*

Last Name*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email*

NI Number*

Phone

Please write your phone number in international format, excluding the symbol (e.g 4477*****).

Do you hold a full driving licence valid in the UK?*

Yes

Preferred Hours

Work Hours*

Week Days

Week Nights

Weekend Days

Weekend Nights

Please tick which shifts you prefer to work

Educational Qualifications

College/University Education

High School Education

Ongoing Professional Development

Other Training Courses

Current Membership of any Professional Body

Employment History

Please give details of employment history starting with your current or most recent employer. Please continue in Notes area if required.

Name of Employer*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Employment Address

Position Held*

Start Date*

End Date*

Reason for leaving*

Brief description of duties*

Name of Employer

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Position Held

Start Date

End Date

Reason for leaving

Brief Description fof duties

Name of Employer

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Position Held

Start Date

End Date

Reason for leaving

Brief description of duties

Name of Employer

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Position Held

Start Date

End Date

Reason for leaving

Brief description of duties

Qualifications/Disqualifications

To ensure the safety of our clients an Enhanced DBS (formerly CRB) check must be completed for all positions. A criminal record will not necessarily be a bar to obtaining a position withSwift Care Agency Healthcare. If a check is returned And reveals any information, this will be discussed with the applicant. The Director(s) will make a decision as to whether the offer of employment should be withdrawn.
Rehabilitation of Offenders Act 1974 (Exceptions)(Amendment) Order 1986

We would draw your attention to the following statement:-

"Because of the nature of the work for which you are applying, this post is exempt from the provisions of Section 4(2) of the Rehabilitation of Offenders Act, 1974, by virtue of the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975 and the Rehabilitation of Offenders Act 1974 (Exceptions) (Amendment) Order 1986.

Applicants are, therefore, obliged to disclose information about any convictions which for other purposes would be regarded as ‘spent’ under the provisions of the Act". Failure to disclose such convictions could result in dismissal or disciplinary action by the employing organisation. Any information given will be confidential and will be considered only in relation to any post to which the conviction applies.

Have you at any time received or had pending, a court conviction in the UK or overseas? If yes please give detail*

Yes

Are you aware of any Police enquiries undertaken following allegations made against you, in the UK or Overseas? If yes please give details*

Yes

Are you subject to any fitness to practice conditions or have you been suspended or dismissed from any job?*

Yes

Description*

References

Please give the detail of two references. We will take up professional references once you have been interviewed and provisionally offered a post. Please make sure that you have given the full contact details of your referees so that this does not delay processing reference requests.

If you have no employer references, we will take up references with named individuals at colleges where you have studied, or people who know you in a professional capacity. Please do not put down family members or people you live with as referees.

Name of Referree*

First Last

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Relationship to you*

Phone*

Referee's Phone Number

Email*

Referree's Email address

Working Time Directive

The Working Time Regulations 1998 state that you are unable to work in excess of an average of 48 hours per week (calculated over a 17 week period) unless agreed with the Swift Care Agency Healthcare Personnel that this limit should not apply.
Swift Care Agency Healthcare wishes to have an agreement with you, which will apply until terminated by notice:

1. The average 48 hour work limit will not apply to you.

2. This agreement may be terminated by yourself by giving Swift Care Agency Healthcare 4 weeks written notice.

If you accept this proposal please tick the check box. This will be a record of this agreement between you and Swift Care Agency*

I accept

I do not accept

Date of Agreement*

Declaration

Please complete the following declaration by ticking the box below. If this declaration is not completed then your applicatiuon will not be accepted.
I agree that Swift Care Agency Healthcare can create and maintain computer and paper records of my personal data and that this will be processed and stored in accordance with the Data Protection Act 1998.

I confirm that all the information given by me on this form is correct and accurate and I understand that if any of the information I have provided is later found to be false or misleading, any offer of employment may be withdrawn or employment terminated.

Please tick check box to confirm agreement with above declaration*

I agree

I do not agree

Declaration Date*

Phone

This field is for validation purposes and should be left unchanged.