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Home
About us
Our Services
Staffing
Request Us
Apply Now
Contact
Log in

Apply Now

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Apply Now

Application Form

This form should be completed and all the supporting documentation should be uploaded where required.

1Your Personal Details

2Employment & Education

3Skills & Policy

4Declaration & Terms

Post Applying for:*
How did you hear about this us?*
Date available to start*
DD slash MM slash YYYY
Personal Details 1
Name*
Title First Name Middle Name Last Name
Home Phone
Mobile No*
Email*
Date of birth*
DD slash MM slash YYYY
National Insurance No:*
NMC Pin No:*
RCN Number:*
HPC Number:*
Band*
Address
Your Current Address*
Street Address Address Line 2 City County / State / Region ZIP / Postal Code Country
Personal Details 2
Nationality*
-
Gender*
Religion*
Race/Ethnicity
Sexual Orientation*
Upload ID Photo*
Accepted file types: jpg, gif, png, jpeg, Max. file size: 5 MB.
This Photo will be used on your ID badge as well as your profile, make sure you face is clear.
Employment Eligibility
Are you permitted to work in the United Kingdom?*
- Yes
- No
Can you provide evidence to prove eligibility?:*
- Yes
- No
What visa/permit/status do you currently hold?:*
- Student Visa
- Work Permit
- Leave to Remain
- Other
Please state what visa/permit you hold:
Permit/Document No:*
Passport No:*
Visa/Permit Expiry Date:*
DD slash MM slash YYYY

If it has no expiry please put a day 10 years from today.
Upload a copy of your passport/pemit
Drop files here or

Accepted file types: jpg, gif, png, pdf, jpeg, Max. file size: 10 MB, Max. files: 4.
You can also take a clear picture from your phone, or can also bring original document/s with to the interview.
Upload a proof of address and other relevant documents
Drop files here or

Accepted file types: jpg, gif, png, pdf, Max. file size: 10 MB, Max. files: 4.
You can also take a clear picture from your phone, or you can also bring original document/s with to the interview.
Driving Details
Do you have a Driving Licence that allows you to drive in the UK?*
- Yes
- No
Driving Licence No:*
Do you have access to a car that you can use for work?*
- Yes
- No
Are all your vehicle documents up to date and valid?*
- Yes
- No
How would you travel to work if assigned?*
Langauages
English - Spoken*
- Fluent
- Good
- Fair
English - Written*
- Fluent
- Good
- Fair
Other Languages Spoken
Do you have proof or English Language?*
- Yes
- No
This can be either IELTS, ECCTIS, or Degree certificate issued in the UK
Please note: you have to provide copies of all IELTS/Proof of English certificates held by you.
Next of kin details
Name*
Prefix First Last
Relationship to you:*
Home/Work Phone
Mobile No*
Email
Address*
Street Address Address Line 2 City County / State / Region ZIP / Postal Code Country
About Work
When are you able to work?*
- Mornings
- Evenings
- Afternoons
- Occasional Weeks
- Full Time
- Part Time
- Nights
- Weekends
- Anytime
Would you be willing to work at short notice?*
- Yes
- No
Do you have any commitments that reduce your flexibility to work?*
- Yes
- No
If yes, please state:

EDUCATION & EMPLOYMENT HISTORY
Your History
Please ensure you complete this section even if you have a CV. Please ensure that you leave no gaps unaccounted for and it covers full work history including your education. Please use extra paper if required. Full work history including your education Dates to and from are shown in a mm/yy format Dates are continual with NO gaps Where there have been gaps in work history please state the reason for the gaps Lists all relevant training undertaken
Please ensure you complete this section even if you have a CV. Please ensure that you leave no gaps unaccounted for and it covers full work history including your education. Please use extra paper if required.

Full work history including your education
Dates to and from are shown in a mm/yy format
Dates are continual with NO gaps
Where there have been gaps in work history please state the reason for the gaps
Lists all relevant training undertaken
Employment History*
Employer Position Duties Date From - To Reason for Leaving
Education
Education*
Institution Course Year Grade
Upload CV if you have one.
Max. file size: 256 MB.
REFERENCES
Please supply us with two professional referees. One must be from your present or most recent employer and must be a senior grade to yourself and you must have worked for that person for a period of not less than three months duration.
Reference 1
Relationship*
Name*
First Last
Email*
Enter Email Confirm Email
Phone*
Address*
Street Address City County / State / Region ZIP / Postal Code
Reference 2
Relationship*
Name*
First Last
Phone*
Email*
Enter Email Confirm Email
Address*
Street Address City County / State / Region ZIP / Postal Code

SKILLS, EXPERIENCE & TRAINING
Have you completed mandatory training within the last year?*
- Yes
- No
Mandatory Policy
Please tick if you have completed the following training within the last 12 months*
- Moving & Handling
- Basic life support
- Health and Safety
- Fire Safety
- First Aid
- Infection Control
- Food Safety & Nutrition
- Medication Administration
- Safeguarding Vulnerable Adults & Children
- Hazardous Substance
Please enclose copies of your training certificates
Policy Dates:
Please add dates of training.
Have you completed other health care training?*
- Yes
- No
Other Policy/Courses & Qualifications
Please check which training you have completed and the date on the notes (certificates must be provided).
- Diploma in Health & Social Care L3
- Diploma in Health & Social Care L2
- Personal Safety (Mental Health & Learning Disability)
- Intermediate Life Support
- Advanced Life Support
- Complaints Handling
- Handling Violence and Aggression
- DOLLS & Mental Capacity
- COSHH
- Data Protection
- Equality & Inclusion
- Lone Worker Policy
- Resuscitation of the Newborn (Midwifery)
- Interpretation of Cardiotocograph Traces (Midwifery)
Policy Dates
Please add dates of training.
YOUR DBS STATUS & UNIFORM
DBS Status
Please send a copy of your most recent DBS Disclosure (formally known as CRB)
Do you have a current DBS (Disclosure Barring Service) (formally known as CRB)?*
- Yes
- No
Current DBS Disclosure (formally known as CRB)
Clear*
- Yes
- No
Date of issue:*
DD slash MM slash YYYY
Disclosure number
All applicants who cannot provide a registered DBS or full immunisation record will be required to complete at their own cost. The company will cover the cost of any Mandatory Policy updates however cancellations outside of 48 hours and late attendances will be charged to the candidate.
Uniform
Candidates will be required to obtain a uniform if successful. Additional uniform costs £10 this will be deducted from your timesheet once you have started working through us. Please fill in the box below stating your uniform size and quantity.
Your Tunic Size*
Your Tunic Size*

DBS DECLARATIONS
Disclosure Barring Service (DBS)
The Disclosure and Barring Service (DBS – formerly Criminal Records Bureau CRB) is the executive agency of the Home Office responsible for conducting checks on criminal records. We are registered body for receipt of DBS disclosure information. NHS Trust and Private Sector hospitals and nursing homes insist on agencies making information recruitment decisions which require DBS checks to be made on all staff. It is a condition of proceeding with your application that you apply for a DBS disclosure check. The disclosure will be compared with the information given below and any inconsistencies could invalidate your application or lead to the cancellation of your registration with us.
Have you been convicted of a criminal offence?*
- Yes
- No
Have you ever been cautioned or issued with a formal warning for a criminal offence?*
- Yes
- No
If you have answered ‘yes’ to either of the above questions please list details including dates below
*
- I confirm the above is true and I understand that a DBS check will be sort in the event of a successful application.
Rehabilitation of Offenders Act 1974 and Criminal Records
By the virtue of the Rehabilitation of Offenders Act 1974 (Exemptions) (Amendments) Order 1986 the provision of section 4.2 of the Rehabilitation of Offenders Act 1974 do not apply to any employment which is concerned with the provision of health services and which is of such a kind to enable the holder to have access to persons in receipt of such services in the course of his/her normal duties. You should there force list all offences below even if you believe them to be ‘spent’ or ‘out of date’ for some other reason.
Right To Work
It is a legal requirement that before any offer of work can be made all candidates provide the company with confirmation of their eligibility to work in the UK by providing one of the original documents detailed below.
- A passport which describes the holder as a British Citizen or as having a right of abode in the United Kingdom or a passport or other travel document to show that the holder has IDENFINITE LEAVE TO REMAIN in the United Kingdom and is not precluded from taking the work in question.
- A passport or identity card issued by a State which is party to the European Union and EEA Agreement and which describes the holder as a national or a state which is a arty to that agreement.
- A letter issued by the Home Office or the Department of Education and Employment indicating that the person named in the letter has permission to take agency work in question or a biometric residence permit.
Work Time Directives
It is a legal requirement that before any offer of work can be made all candidates provide the company with confirmation of their eligibility to work in the UK by providing one of the original documents detailed below.
*
- I DO NOT wish to work more than 48 hours per week
- I DO wish to work more than 48 hours per week
Registration form Declaration
I declare that all information given in this registration form is to the best of my knowledge complete and accurate in all respects and that I am eligible to work in the UK.
Registration form Declaration
I declare that all information given in this registration form is to the best of my knowledge complete and accurate in all respects and that I am eligible to work in the UK. I understand that any false or misleading information may result in my removal from SNA’s register of members.
Signature*
Please sign here.
Today's Date*
DD slash MM slash YYYY
Full Name:*
Your History
Please ensure you complete this section even if you have a CV. Please ensure that you leave no gaps unaccounted for and it covers full work history including your education. Please use extra paper if required. Full work history including your education Dates to and from are shown in a mm/yy format Dates are continual with NO gaps Where there have been gaps in work history please state the reason for the gaps Lists all relevant training undertaken
Privacy*
- By using this form you agree with the storage and handling of your data by this website as defined in our Privacy Policy *
Phone
This field is for validation purposes and should be left unchanged.

BLUE CROSS HEALTHCARE SERVICES LIMITED

We specialise in the supply of temporary and permanent nursing, care and support staff to a wide range of clients including hospitals and care homes.

Make an Enquiry!

Services

Live-In Care
Nursing Care
Respite Care
Domiciliary Visiting Care

Information

Age UK
Dementia UK
Skills For Care
CQC
Health & Social Care

Contact Info

Address:
9E, Southbridge House,
Southbridge Place,
Rathbone Square, Croydon.
CRO 4HA
Business hours:
24/7 Emergency Staffing
Landline
020 8240 4489
Mobile:
07853 371288

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