1Personal Details2References3Education & Training4Work History5Criminal Records6Upload Documents7Declarations TitleMrMrsMissNot to saySurname(Required) First Name(Required) First Date of Birth: MM slash DD slash YYYY Email(Required) Gender Male Female Prefer Not to Answer Full Address Street Address City Postcode Home telephone number:Mobile No:(Required)Title of Job You Are Applying For:(Required)Care AssistantNurseSenior Care AssistantNational Insurance Number(Required) NMC Pin No: (Nurse only) NMC Pin Expiry date (Nurse only) MM slash DD slash YYYY Your Bank Account Detail:Account Holder Name(Required) Account Number(Required) Sort-Code(Required) Bank Name(Required) Do you hold a full current driving licence?(Required) Yes No Do you have access to reliable transport?(Required) Yes No Uniform Size(Required) S M L XL Name of Emergency Contact(Required) Relationship To you(Required) Work Telephone No(Required) Home Telephone No(Required) Please give the names and contact details of at least 2 professional referees that cover the last 3 years work history – one must be your most recent employer. Feel free to continue on the Additonal Notes Page if necessary. All referees, including character referees, must have worked in a senior position to yourself and must also return the reference from a professional email address or on letterhead paper. Please be aware that Capital Recruitment Ltd are unable to offer you work until satisfactory references have been obtained, and that Capital Recruitment Ltd are required to obtain references for you on an annual basis.Reference 1Organisation:(Required) Dates employed:(Required) MM slash DD slash YYYY Referee name:(Required) Professional Work Address(Required) Email(Required) Telephone(Required)Capacity in which known: Can we contact immediately? Reference 2Organisation: Dates employed: MM slash DD slash YYYY Referee name: Professional Work Address: Email: Telephone:Capacity in which known: Can we contact immediately? Name & address of education establishment Qualifications achieved and grades: Name & address of education establishment Qualifications achieved and grades: Name & address of education establishment Qualifications achieved and grades: Name & address of education establishment Qualifications achieved and grades: Name & address of education establishment Qualifications achieved and grades: Please continue on a separate sheet if necessaryANY OTHER TRAINING Please provide your full work history from leaving school to the present day. Please also account for any gaps in your employment history. NAME OF EMPLOYER DATE FROM DATE TO POSITION HELD REASON FOR LEAVING NAME OF EMPLOYER DATE FROM DATE TO POSITION HELD REASON FOR LEAVING NAME OF EMPLOYER DATE FROM DATE TO POSITION HELD REASON FOR LEAVING NAME OF EMPLOYER DATE FROM DATE TO POSITION HELD REASON FOR LEAVING Criminal RecordsPlease note that under new filtering rules - certain offenses may be removed from your criminal record after 11 years (5.5 years if you were under the age of 18) Cautions will be removed after 6 years (2 years if you were under the age of 18); providing that this was your only offence and did not result in a custodial sentence. Serious offences will never be filtered. If you are unsure of whether your conviction/caution/reprimand is filtered, please see the DBS website for more information before signing the declaration. If you do not declare a conviction/caution/reprimand that later appears on your DBS this could result in dismissal or non-employment. Please tick:Do you have any convictions, cautions or reprimands that are not “protected” as defined by the Rehabilitations of Offenders Act (amended 2013)?(Required) YES NO Are you aware of any Police enquiries undertaken following allegations made against you, which may have a bearing on your suitability for this post?(Required) YES NO Have you ever had a Police check in another country? If so, please provide details below and enclose a copy if held.(Required) YES NO If you have answered yes to any of the above, please give details below:Please note that if at any stage whilst working for Capital Recruitment Ltd we receive a DBS Enhanced Disclosure that highlights information you have not declared, then you will be removed from your assignmen 48 HOURS OPT OUT AGREEMENTWorking Time Directive The Working Time Regulations 1998 require Care3sixy Ltd to limit your average weekly working time to 48 hours unless you agree with Care3sixy Ltd that the limit shall not apply to you:(Required) I agree that I may work for more than an average of 48 hours a week. If I change my mind I will give Care3sixy Ltd at least 3 months’ notice in writing to end this agreement Passport (including front cover) Drop files here or Select files Max. file size: 256 MB. Right to work documentation (Visa / Biometric card) – Front and back Drop files here or Select files Max. file size: 256 MB. CV Drop files here or Select files Max. file size: 256 MB. DBS certificate (Dated within 12 months) Drop files here or Select files Max. file size: 256 MB. DBS Certificate Number DBS Issue Date Covid Pass vaccine Certificate(Required) Drop files here or Select files Max. file size: 256 MB. Mandatory training Certificate (in Date) Drop files here or Select files Max. file size: 256 MB. X2 Proof of address Drop files here or Select files Max. file size: 256 MB. National Insurance Letter Drop files here or Select files Max. file size: 256 MB. Photo for ID badge Drop files here or Select files Max. file size: 256 MB. Consent(Required) I accept terms & conditions(Required)I hereby give my consent to Care3sixy Ltd to process the following information: Personal data, including name, date of birth, contact details, including telephone number, email address and postal address, experience, training and qualifications, CV, National Insurance Number, sensitive personal data including disability/health assessments relevant to the role, criminal convictions/DBS checks and reference checks. I consent to Care3sixy Ltd processing the above personal data for the following purposes: • For the Care3sixy Ltd to provide me with work-finding services • For the Care3sixy Ltd to process with or transfer my personal data to their named client/s in order to provide me with work-finding services. • For the Care3sixy Ltd to process my data on a computerised database provided by named provider in order to provide me with work-finding services • For the Care3sixy Ltd to process my data using automated decision making processes • I acknowledge and confirm that The Care3sixy Ltd is authorised to apply for and obtain references from any previous employers and educational establishments and agree that these organisations may release my information. • I also consent to the Care3sixy Ltd processing my personal data with third parties for the purposes of internal audits and investigations carried out on the Care3sixy Ltd to ensure that the Care3sixy Ltd is complying with all relevant laws and obligations. • The consent I give to the Care3sixy Ltd will last for one year from providing me with work finding services. • I am aware that I have the right to withdraw my consent at any time by informing the Care3sixy Ltd that I wish to do so. • I understand that if I am charged or cautioned criminally after signing this declaration, I must inform The Care3sixy Ltd immediately. I will inform the Care3sixy Ltd if I am under investigation or have been suspended by my regulatory body or another employer at any point immediately. • I acknowledge that if there are any changes to my personal particulars I must inform The Care3sixy Ltd immediately in writing prior to the change coming into effect. This includes any changes to name, address, bank details or gender. • I acknowledge that my personal details will be stored and handled correctly by The Care3sixy Ltd in accordance with the Data Protection Act 1998. • I give my permission to share any required information from my personnel file with any third party professional that may need to view my details. These details may be required to be made available for audit/review by relevant third party bodies due to compliance and legislative control measures. This is relevant for all information including all documents such as DBS, references and occupational health. • I give my permission for The Care3sixy Ltd to run a Right to Work check with the Home Office if required. I understand that if I am a student or on a sponsorship visa I can only work a maximum of 20 hours per week. I understand that I have the responsibility to monitor this. In addition if my eligibility to work in the UK position changes I will inform the Care3sixy Ltd. • I give consent for the completion of an enhances Disclosure and Barring Service application from via eBulk electronic submission, if applicable. • I agree that I have represented my true identity and will corroborate my identity to be true via documentation for these purposes. • I acknowledge and confirm that The Care3sixy Ltd is authorised to apply for and obtain references from any previous employers and educational establishments and agree that these organisations may release my information. • I understand that Care3sixy Ltd reserves the right to refuse an application on the grounds of unsatisfactory referencing, training attendance, unsatisfactory conduct whilst undertaking training, undisclosed criminal convictions, unacceptable identity documentation, false work or incorrect address history information. • I am aware that under no circumstances will I apply or accept an invitation of employment or engagement within any Care3sixy Ltd, client, establishment, service user or organisation in which Care3sixy Ltd has introduced me to. I am aware that if I want to work within an organisation that Care3sixy Ltd has introduced me to I will follow Care3sixy Ltd procedure which starts with informing my line manager. • I understand that my data may be used by Care3sixy Ltd for marketing and advertisement purposes such as mailshots. • I understand that the data will not be sold or made available to any third-party and that the data will not be used for any purpose that contravenes the Data Protection Act as in force at the time. • I declare that the information given herein is, to the best of my knowledge, true, complete and accurate in all respects and not presented in any way to mislead. I understand that knowingly giving false information will disqualify me from work with Care3sixy Ltd. I agree that if I have given misleading information now or in the future, that Care3sixy Ltd may cease to offer me work without notice.
