Online Application – Staff Support Services

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Staff Support employment Application

First Name

Last Name

Address

City

County

Post code

Phone

Email

Do you have any convictions, cautions, reprimands or final warnings which are not protected as defined by the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975 (as amended in 2013)? *

Yes No

Are you eligible to work in the UK?

Yes No

Do you consent to Staff Support undertaking 'Right to Work' checks? (if applicable)

Yes No

Do you consent to Staff Support undertaking a DBS check?

Yes No

Do you have at least six months experience?

Yes No

What role are you interested in?

Registered Mental Health Nurse Registered General Nurse Healthcare Assistant Registered Nurse - Learning Disabilities

What type of employment are you seeking?

Part Time Full Time Temporary

Please select relevant clinical areas that you have experience in

Eating Disorders Personality Disorders Learning Disability Elderly Care Child and Adolescent Forensic Nursing Drug And Alcohol Community Mental Health

Where would you like to work?

Bristol & Bath Somerset Devon Gloucester South Wales Berkshire Surrey Hertfordshire Oxford Sussex Hampshire (Southampton)

Are you willing to travel?

Yes No

Do you own a car?

Yes No

Briefly, in your own words, describe why you are an ideal candidate for this position

Have you ever been employed by Staff Support before?

Yes No

Do you have any relatives employed by Staff Support?

Yes No

NEXT OF KIN

Name of next of kin

relationship to you

Phone number

Address

EDUCATION

COLLEGE / HIGHER EDUCATION

Name of college

Dates Attented

address

Qualifications Gained

UNIVERSITY

Name of University

Dates Attented

address

Qualifications Gained

PREVIOUS EMPLOYMENT

YOU MUST INCLUDE YOUR CURRENT AND PREVIOUS EMPLOYER DETAILS WITH START AND END DATES

CURRENT OR MOST RECENT EMPLOYMENT

EMPLOYERS NAME

EMPLOYERS ADDRESS

EMPLOYMENT DATES

EMPLOYMENT TYPE

Full Time Part Time Temporary

BASIC ANNUAL SALARY

ADDITIONAL SALARY

JOB TITLE

JOB DESCRIPTION

MANAGER'S NAME

MANAGER'S PHONE NUMBER

REASON FOR LEAVING

PREVIOUS EMPLOYMENT 2

EMPLOYERS NAME

EMPLOYERS ADDRESS

EMPLOYMENT DATES

EMPLOYMENT TYPE

Full Time Part Time Temporary

BASIC ANNUAL SALARY

ADDITIONAL SALARY

JOB TITLE

JOB DESCRIPTION

MANAGER'S NAME

MANAGER'S PHONE NUMBER

REASON FOR LEAVING

PREVIOUS EMPLOYMENT 3

EMPLOYERS NAME

EMPLOYERS ADDRESS

EMPLOYMENT DATES

EMPLOYMENT TYPE

Full Time Part Time Temporary

BASIC ANNUAL SALARY

ADDITIONAL SALARY

MANAGER'S PHONE NUMBER

JOB TITLE

JOB DESCRIPTION

MANAGER'S NAME

REASON FOR LEAVING

REFERENCES

PLEASE PROVIDE AT LEAST TWO REFERENCES. REFERENCES MUST INCLUDE YOUR MOST RECENT/CURRENT EMPLOYERS AND COVER A MINIMUM OF 3 YEARS. IF YOU DO NOT INCLUDE THE CORRECT REFERENCE INFORMATION IT MAY DELAY YOUR REGISTRATION

Do you consent to Staff Support contacting your references?

Yes No

REFERENCE 1

NAME

POSITION

COMPANY

ADDRESS

PHONE NUMBER

EMAIL ADDRESS

REFERENCE 2

NAME

POSITION

COMPANY

ADDRESS

PHONE NUMBER

EMAIL ADDRESS

REFERENCE 3

NAME

POSITION

COMPANY

ADDRESS

PHONE NUMBER

EMAIL ADDRESS

Do you consent to Staff Support Healthcare holding your data for the purposes of finding you employment?

We interpret our legal basis for processing your data is legitimate interest and consent so that we may represent you to our clients who have appropriate vacancies.

Yes No

Checking the box above is equivalent to a handwritten signature

I confirm that the information I have provided is correct and current.

Checking the box above is equivalent to a handwritten signature

WHERE DID YOU HEAR ABOUT US?

WORD OF MOUTH INDEED STAFFNURSE/JOBMEDIC SEARCH ENGINE UNIVERSAL JOBMATCH OTHER

VERIFICATION

PLEASE ENTER ANY TWO DIGITS

At Staff Support Services Limited, we are dedicated to constantly providing high customer satisfaction by delivering excellent services through our highly experienced and motivated Partners (healthcare assistants, support worker and registered nurses).

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