Nursing Application Form

Please complete all the relevant fields within this form, there are several pages, so ensure all areas are completed correctly.

Please do not to navigate away from, or refresh this page, as the information will be lost.


    Section One: Personal Details







    Section Two: Document Checks

    Driving Licence



    Passport

    Visa


    Section Three : Nursing Qualifications






    Section Four : Full Employment History

    Please provide details of your employment history including the reasons for leaving previous positions

    Current/Most recent employer


    Previous employer employer


    Previous employer employer


    Additional role information Dates, roles, Employment History (including reasons for gaps) / Reason for Leaving)

    Additional Information

    Please supply any other additional information to support your application.


    Section Five : References

    With your permission references will be taken up immediately before interview. Please provide details of two
    professional referees, one must relate to your last period of employment. If this is an agency we will require an
    additional referee who can comment on your professional skills and competences. N.B. Referees must be health
    professionals who have worked with you previously in a senior clinical capacity.



    Section Six : Health & Welfare Information



    Section Seven : Training

    We will need to see original copies of valid certificates

    Moving + Manual Handling



    Life Support


















    Section Eight : Professional Registration & Conduct





    General Data Protection Regulations

    Consultus Care & Nursing Limited will need to collect and process personal data about you such as identity
    data (your name,
    date of birth, marital status, gender etc.), contact data (your address, email address and telephone number)
    in order to carry out
    our services for you.

    We may also need to collect special categories of sensitive personal data (such as information about your
    health, genetic data
    and biometric data) about you in order to protect your vital interests and safety, and in order to carry out
    our services for you.

    A full list of the reasons why we need to process your personal data, how we will process your personal data
    and what personal
    data and sensitive personal data we will collect from you are set out in our Privacy Policy. A copy of this
    is available to view on
    our website.

    You have the right to withdraw your consent at any time where we are relying on your consent in order to
    process your data.
    This will not affect the lawfulness of any processing carried out before you withdraw your consent. If you
    withdraw your consent,
    we may not be able to provide our services to you. We will advise you if this is the case at the time you
    withdraw your consent.

    This information may come from you, your referees, the Disclosure and Barring Service or other persons or
    organisations.
    We do this in order to:

    • Assess your skills, suitability and eligibility to be registered with us as a nurse
    • Allow us to meet legislation including the Employment Agency Act 2003 (Conduct of Employment Agencies &
      Employment
      Businesses regulations), which requires an agency to inform a hirer of any information that gives them
      grounds to believe a
      work-seeker is or may be unsuitable
    • To assist in finding you employment with appropriate clients if you subsequently become a nurse with
      this agency


    I consent to Consultus Care & Nursing Limited processing my personal data and sensitive personal data in
    accordance with the Privacy Policy


    Rehabilitation of Offenders Act

    The nature of the work for which you are applying is considered to be exempt from the provisions of the
    Rehabilitation of
    Offenders Act 1974 (Exceptions) (Amendment) (England and Wales) Order 2009. Applicants are required to give details
    of all
    convictions for criminal offences, including those which would otherwise be considered as “spent” by virtue of the
    said Act.
    Failure to give details of convictions could result in dismissal or disciplinary action by the appropriate
    Authority. Information
    given will be considered only in relation to this application or applications for other employment carrying this
    exemption.

    Please give below, or on a separate sheet if preferred, details of all convictions including those which would
    otherwise be considered as “spent” and any hearings pending. If you have never been convicted of a criminal
    offence please write “no spent or unspent convictions”.


    • I declare that the information I have given in this application is to the best of my knowledge true and correct
      and, if selected, I agree to abide by the Consultus Contract for Services
    • I declare that to the best of my knowledge there are no medical reasons which would prevent me from
      undertaking the role of a live-in nurse with Consultus


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