Online Nurse Application – LEHD Solutions

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Personal Details

Prefix

First Name

Middle Name

Last Name

Gender *MaleFemale

Date of Birth *

Month *

Day *

Year *

Age *

Marital Status *

Religion *

National Insurance *

Email Address *

Phone Number *

Home Telephone *

Preferred time of contact *MorningAfternoonEveningNightAny

Street Address *

City *

State/Province *

ZIP / Postal Code *

Country *

Data Protection

Consent *

Yes, I agree with LEHD Solutions Ltd Data Protection Policy

How did you find us

How did you find us?

Job Preference

Type of Position *GRNRMNOther

Other Position *

Type of work preferred *NHSHospitalNursing HomeResidential HomeOthers

Other work pref. *

Work type *Short termLong term

When would you like to work? *Part timeFull timeBank holidayEvening (Mon - Fri)Days (Mon - Fri)Evening (Sat - Sun)Days (Sat - Sun)Night (Sat - Sun )Live in care

When are you available to work? *

When can you come for an interview? *

Professional Education & Training

Please list any Training/Course/Nursing Qualification you have and when you gained 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 *

Children under 18 years ? *

Are you a fully qualified nurse ?

PIN Number *

PIN number expiry date *

Studying Nurse *

Name of College/University *

Expected date of graduation *

Do you have a driving license ? *

Registered Disabled ? *

Disability Registration Number

Dismissal & Conviction Information

The protection of vulnerable workers 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 convictions? *

Convictions 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 checking the details I have provided against the various data sources in order to verify my identity and process this application. This details may be used to assist other organization such as CRB , NMC, in identity purposes.

Do you currently hold DBS *

What type of DBS *

DBS Number *

Date of Issue *

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's name *

Phone Number *

First Referee's Email Address *

Street Address *

State/Province *

ZIP / Postal Code *

Country *

Prefix

First Name

Last Name

Company's name *

Phone Number *

Second Referee's Email Address *

Street Address *

State/Province *

ZIP / Postal Code *

Country *

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

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