Application Form

Join Our Team

Are you interested in joining our team and working for us? Do you have all the necessary training? Are you able to work in the UK?

Then fill in your details in our application form and if you qualify, we will call you in for an interview…

Our Recruitment Services

We are always looking to add highly competent permanent care and nursing staff to our team at very competitive rates. We are selective in our recruitment and we offer comprehensive induction and training to all our staff. To us, excellence is not a skill, its an attitude!

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If you have any difficulty or need help to complete this form, please call 0333 090 3322 / 07936 509190 for assistance.

Position applied for *

Healthcare Assistant
Healthcare support Worker
Senior Care Assistant
Care Coordinator
Registered Nurse

Type Of Work *

Temporary
Permanent

I Confirm that i am allowed to work in the UK *

How do you get to work? *

Car
Bicycle
Public Trasport

Title *

First Name *

Last Name *

Gender *

Male
Female

Date of Birth *

Address *

City *

Postal / Zip Code *

Country *

Phone *

Email *

National Insurance Number *

Do you consider yourself to have a disability? *

Name *

First

Last

Address *

Phone *

PREVIOUS EMPLOYMENT AND REFERENCES

Reference 1

Company Name *

Line Manager *

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Phone *

Email *

Date from *

Date to *

Reasons for Leaving *

Breif Description of Duties *

Reference 2

Company Name *

Line Manager *

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Phone *

Email *

Date from *

Date to *

Reasons for Leaving *

Breif Description of Duties *

Have you had any other employers in the last 5 years? *

Working Time *

less than 16 hours a week
between 16 - 30 hours a week
more than 37.5 hours a week

Please check the box below if you are willing to work more than 48 hours I am willing to work more than 48 hours per week on average.

Bank Details

Bank Name *

Account Number *

Sort Code *

Your name as it appears on your account *

Do you have a P45 *

Work Wear *

Small
Medium
Large

DISCLOSURE – Please read carefully *

Please check this box to read agreement and procede

Due to the nature of the work for which you are applying, you must disclose any information regarding any criminal convictions either current or which would normally be considered as spent. This is provided for by virtue of the 1975 Exceptions Order to Section 4 (II) of the Rehabilitation of Offenders Act (1974). You must also disclose details of any cautions, which, when given, you admitted. All information will be treated in strictest confidence. Any pending offences, for which you are awaiting an outcome, must be disclosed. In addition, during your period of engagement with VINE Recruitment, you should inform us if you are convicted, or are awaiting an outcome, of any new offences (including motoring offences.)

I confirm that I DO NOT have any cautions, charges or convictions *

Yes
No, i do not confirm

Name *

First

Last

Date *

CONFIDENTIALITY AGREEMENT *

Please check this box to read agreement and procede

Confidential information is defined as any information found in a patient’s medical record/Service User Health File, personal information, and work-related information (including salary information). All information relating to a patient/Service User’s care, treatment, or condition constitutes confidential information. This confidentiality policy also encompasses any trade secret, scientific or technical information developed by the Client or its personnel. Employees shall never discuss a patient/Service User’s medical condition with any non-employee of the Client, friends, or family members. Confidential matters involving patient/service user will not be discussed in areas where they might be overheard by other patients/service users or other non-employees of the Client. Staff members are to be aware at all times that conversations regarding patient/service user are not to be overheard by others and take appropriate steps to ensure this confidentiality. Any unauthorized disclosure of confidential information by Temps could render the Client liable for damages. Any Temp who violates the confidentiality of Client, medical- or Staff-related information is subject to disciplinary action up to and including termination from placement.

Please check the box below *

I have read, understand, and agree to uphold this written policy on matters of confidential information and trade secrets.

Full Name *

Date *

GENERAL DATA PROTECTION REGULATIONS (GDPR)

Can we keep and process your data (Previous experience Skills and Qualifications) *

This will allow us to make a decision on your suitability for employment.

Can we keep and process your data (Strictly controlled data) *

This will allow us to make a decision on your suitability for employment.

Can we keep and process your data (Name, address etc) *

This enables us to comply with the law and maintain correct employment records.

Can we keep and process your data (Next of kin and their contact details) *

Next of kin and their contact details

Can we keep and process your data (Health/ disability information and GP details) *

So that we are aware of any medical issues you may have, we can make provision for these in your work and know who to contact if you have a medical episode.

Can we keep and process your data (Bank details, Tax codes, NI number etc) *

This will allow us to comply with the law and register you as an employee with HMRC and share with HMRC how much we pay you. It will also allow us to pay you.

Can we keep and process your data (Bank Details, salary payments) *

We will need to share this information with the Holding account provider so that they can pay your salary to you on our behalf.

Please check both boxes *

I consent to my personal data being made available to authorised third parties in order to comply with current regulations and for the purposes of auditing.
I have no objection to my details being held on computer records and utilised by the company in pursuit of its legitimate business.

SHIFT ATTENDANCE AND CANCELLATION POLICY *

Please check this box

Medical Declaration

Please check this box

For all the good work being done, we sometimes have staff reporting late for shifts or cancelling at the last minute and the worst-case scenario, not attending without informing the office or client. For us to maintain a good reputation with our clients and the vulnerable service users we support, it is vital that we have a committed and reliable workforce at all times. We sometimes end up with some very unhappy clients and it is here that we need your help to continue working in their trust. The more satisfied clients we have, the more the variety of work we would be able to offer our staff. This attendance and cancellations policy ask that you all work with us on this to ensure that we offer a high standard of service to our clients and service users so that we remain the agency of choice for our clients. We will maintain a strict policy on reliability which if their seen to be a continued breach of this policy, this may result in de-registration of candidates as a last resort. The policy stipulates that the following will not be tolerated: Cancelling shifts on more than 2 occasions during a one-month period Cancellation of more than 3 shifts in any 6-month period Leaving a shift before the finish time without permission from VINE or the client Not reporting for duty more than once without informing VINE or the client– this is extremely important as potentially it will leave a vulnerable person alone The policy requires: 100% commitment before accepting a shift 24 hours’ notice for shift cancellation unless it’s an emergency If it’s your first time to a client, ask the office for more information and allow enough time for a quick induction by the client home manager Maintain a Right place, Right time and Right attitude Maintain a good practice of aiming to arrive 10 minutes early to allow for delays when travelling to work We understand that sometimes there will be unforeseen circumstances that are not in your control but generally, a high level of reliability will be expected across the board. Please sign below if you have read and understood the contents and details of this policy.

Do you have any medical conditions that could make it difficult for you to undertake any role in the job you are applying for? *

As part of our recruitment process, we ask that you supply some documents. If you have any difficulty or need help to complete this or any part of the application form, please call 01235 604952/ 07848 149924 for assistance. Please make sure all scans or photographs are legible and pictures are clear before you upload. Failure to do this may result in delays in processing your application form.

ID Document Scan *

Photo ID

Proof of address *

Proof of National Insurance *

Do you have a relevant NVQ? *

Are you currently studying for a relevant NVQ? *

Would you be interested in NVQ training? *

All healthcare professionals are required to do mandatory training. Have you done mandatory training in the last 12 months? *

Please upload certificate(s) here *

Have you done any other courses related to the job you have applied for? *

TRAINED NURSES ONLY

Pin Number

Expiry Date

Do you have a current DBS? *

Let's help you!

Contact us today to arrange free, no-obligation care consultation for you or your loved one. Please fill out the form below. Our caring, capable, knowledgeable team are ready and willing to answer any questions or concerns you may have and will get back to you shortly.

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Our Recruitment Services

TRAINED NURSES ONLY

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