To apply please complete the application form below and one of our team members will respond shortly.
--please select--Care AssistantSupport WorkerSenior Support WorkerSenior Care Assistant
Title: MrMrsMsMissOther
Address
Start date
(*if less than 5 years provide further home address details dates below)
End date
-+
Have you been known by any other name, from the age of 10? (*includes maiden surname) YesNo
Used until:
Date of birth
Eligible to work in the UK and do not require a work permitCurrently in possession of a UK work permitRequired to obtain a work permit to work in the UKOther (please specify)
Do you have a current Enhanced DBS Disclosure Document? If yes, please provide a copy YesNo
Does your Enhanced DBS Disclosure contain any cautions or convictions? If yes, please provide details YesNo
Have you had any disciplinary action taken against you? If yes, please provide details YesNo
Do you consent to Proactive Medicare requesting an enhanced DBS Check, police check and any similar references on your behalf? YesNo
Have you ever been subject to proceedings of medical negligence or professional misconduct? If yes, please provide details YesNo
Have you ever been dismissed or suspended? If yes, please provide details YesNo
Have you ever had any disciplinary action taken against you? If yes, please provide details YesNo
Date from:
Date to:
Alternatively please upload your CV Here:
CHECK TO INDICATE YOUR CONSENT FOR YOUR REFEREES TO BE CONTACTED
CommunityHospitalPrisonResidentialNursing Home
I agree that Proactive Medicare retains the right to hold this application and any other data associated to process it and pass on to any authorized third party the details held within, also to retain the details for as long as reasonably necessary in accordance with the Data Protection Act.
I do NOT consent to work more than 48 hours per weekI consent to work more than 48 hours per week
I hereby confirm that the information given is true and correct. I consent to my personal data and employment/educational history being forwarded to clients. I understand that should the information I have given be untrue I accept full responsibility for any consequences this may bring. I consent to references being passed onto potential employers. If, during the course of a temporary assignment, the client wishes to employ me direct, I acknowledge that the agency will be entitled either to charge the client an introduction/transfer fee, or agree to an extension of the hiring period with the client (after which I may be employed by the Client without further charge being applicable to the Client). We may check the information collected, with third parties or with other information held by us. We may also use or pass to certain third parties’ information to prevent or detect crime, to protect public funds, or in other way permitted or required by law.
In line with the nature of the work I will be undertaking, I understand that the confidential documentation I have given in line with compliance procedures may be audited in relation to the provision of the services at any time and I consent to this.
Do you want to opt out of the Proactive Medicare pension scheme with NEST? YesNo
