Apply for Work

Personal Information

Enter your full name.
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Enter your surname.
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Enter your home address including street, city, and zip.
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Enter your postcode.
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Enter your contact number.
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Enter your National Insurance number.
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Enter the name of your bank.
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Enter your bank sort code.
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Do you hold a full UK driving license?
Select Yes or No.
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Please provide details of any driving endorsements on your license.
Do you have any holidays booked? Please give details.

Education, Professional Experience and Working Details

Preferred Working Hours
Select your preferred working hours.
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Days Available to Work
Select the days you are available to work.
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Where did you study? Include dates and grades.
Details of training, qualifications and updates you have undertaken, with dates.
If you hold any professional memberships, please detail them.
List your last 5 years of work history, including detailed employer information.

Rehabilitation Of Offenders Act 1974

Are you aware of any recent/outstanding allegations/investigations that have been made against you that relate to any safeguarding issues/referrals including any referrals to the Nursing Medical Council, Disclosure & Barring Service (DBS) or Protection of Vulnerable Groups Scheme (PVG)?
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Do you have any spent or unspent convictions, cautions, reprimands or warnings?
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Do you have any pending or unresolved disciplinary action taken against you, either in employment or care related activity?
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Passport and Work Permits

Do you need permission to work in the UK?
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The Official Part

What we need you to do here is read everything carefully and sign at the bottom to confirm your understanding and agreement. If you would rather us talk you through this bit – no problem, let us know.

Qualifications

It is the company’s policy to verify the qualifications of all successful job applicants and you may be asked at a later stage to evidence training and qualifications declared on this form. Please indicate that you confirm understanding
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Working time regulations

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Data protection act 1998 and inspection

We are required to hold personal information on staff such as National Insurance Number, address, qualifications, a mechanism for checking health and fitness including records of immunisations, record of training, annual leave and sickness, written references and Rehabilitation of Offenders information, from time to time we may be required to release elements of this information in placing you in assignments; please be assured that we would only disclose information that is necessary. If you have any concerns about this or want to discuss it further, please contact your branch manager.
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Application declaration

I confirm that the information given on this application form is correct to the best of my knowledge. I understand that any false statement may disqualify me from employment, or render me liable to dismissal. I authorise the Company (Rowina HCS) to approach the employers listed on my application, and carry out all other necessary enquiries to confirm that the employment and educational information is correct. I also authorise the Company (or any company authorised to act on their behalf), to approach any other former employer or educational establishment named on my CV or application form. This information will only be used following either verbal or written acceptance of employment. I understand that any agreement entered into is subject to a probationary period, satisfactory references and enhanced DBS check, successful completion of Selection Training and any other checks, documentary evidence of my National Insurance Number, my right to work in the UK, proof of current address and, if necessary, a medical examination.

1 All of the above declarations, as indicated with ‘yes’
2 The company approaching any Government Agency (including the Department of Works and Pensions (DWP), former employers, places of education and personal referees to verify the information given (please note that your present employer will not be approached until we have issued a conditional offer of employment).
3 My ID being passed to the relevant authority for checking should be necessary.
4 Any concerns regarding the authenticity of my ID and proof of residence being reported to the relevant authority.
5 Rowina Healthcare or nominated third party contacting me after the term of my employment.
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Next Of Kin

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Submit

I agree that by signing this form I consent to Rowina accessing my information
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