Care Staff Application – LEHD Solutions

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Personal Details

Prefix

First Name

Last Name

Sex *MaleFemale

Date of Birth *

Age *

Marital Status *

Religion *

Insurance *

Email Address

Mobile Phone Number *

Home Telephone *

Preferred time of contact *MorningAfternoonEveningNight

Street Address *

City

State/Province

ZIP / Postal Code

Country

Data Protection

The personal data provided in this form will be processed from the legitimate business of LEHD SOLUTIONS LTD in managing your correspondence. We will never sell your data and we promised to keep your data safe and secure.

Data Protection *

Yes, I accept LEHD SOLUTIONS LTD Data Protection Privacy

How did you find us

How did you find us? *

Job Preferences

Position applying for *Care AssistanceSupport WorkCare Team Leader

Type of work preferred *NHSHospitalNursing HomeResidential HomeOthers

Others *

Work type *Short termLong term

How would you like to work ? *Part timeFull timeBank holidayEvening (Mon - Fri)Days (Mon - Fri)Evening (Sat - Sun)Days (Sat - Sun)

When are you available to work? *

When can you come for an interview ? *

Employment History

Please give details of your past 5 years of continuous work history giving reason/s for break in employments. Starting with the current date.

Start Date *

End Date *

Employer *

Street Address *Employers Address

City

State/Province

ZIP / Postal Code

Country

Employers Phone *

Main Contact *Employers Main Contact

Post Title *

Grade *

Type of Job *

Reason(s) for Leaving *

Other Employer ? *

Start Date *

End Date *

Employer *

Street Address *Employers Address

City

State/Province

ZIP / Postal Code

Country

Employers Phone *

Main Contact *Employers Main Contact

Post Title *

Grade *

Type of Job *

Reason(s) for Leaving *

Professional Education & Training

Please list any Training/Course/Caring Qualification you have and when you have them

Qualification 1 *

School/College University *

Dates Gained *

Qualification 2

School/College University

Dates Gained

Any more qualifications ?

Qualification 3

School/College University

Dates Gained

Do you require work permit to work in the UK ? *

Do you have immigration permission to work in the UK ? *

Work Permit Type *

Work Permit Expiry Date *

Please explain your situation *

Nationality *

Passport Number *

Passport Expiry Date *

Ethnic Origin *

Number of Children under 18 *

Studying Nursing ?

Name of College/University *

When did your graduate *

Do you have a drivers license ?

Registered Disabled ?

Disability Registration No. *

Dismissal & Conviction Information

The protection of vulnerable adults requires us to carry out checks on police records for applicants whose assignments will give them substantial access to vulnerable adults. You are advised that this post is exempt from the provision of Section 4(2) of the Rehabilitation of Offenders Act 1974. You are not entitled to withhold information about any criminal conviction which for other purposes are "spent" under the provision of the Act. The information given will be treated in the strictest of confidence and only taken into account where, in the reasonable opinion of LEHS SOLUTIONS LTD, the offence is relevant to the post of which you are applying. Failure to declare a conviction may require us to exclude you from our register or terminate an assignment if the offence is not declared but later comes to light.

Have you been dismissed from any other employment? *

Dismissal details *

Have you ever been convicted of a criminal offence? *

Offence details *

Do you have any spent or unspent conviction ? *

Conviction details *

Have you instigated an enhanced disclosure within the last six(6) years?

Permission to check the details provided *

I CONSENT TO LEHD SOLUTIONS LTD TO CHECK THE DETAILS I AVE PROVIDED AGAISNT THE VARIOUS DATA SOURCES TO VERIFY MY IDENTITY AND PROCESS THIS APPLICATION. THESE DETAILS MAY BE SHARED WITH OTHER REVELANT ORGANIZATIONS REGARDING THIS POSITION.

Job References

Please nominate two references. The nominated persons must be your employer, especially a mentor or boss, but not a family relative.

Prefix

First Name

Last Name

Company Name *

Phone *

First Referee's Email Address *

Street Address *

City

State/Province

ZIP / Postal Code

Country

Prefix

First Name

Last Name

Company Name *

Phone *

Second Referee's Email Address *

Street Address *

City

State/Province

ZIP / Postal Code

Country

Do you consent to LEHD SOLUTIONS LTD requesting reference from your referees? *

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LEHD Solutions Ltd is a center for excellent recruitment services

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