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Welcome to our Recruitment & Registration page, please take a moment to complete the Candidate Registration form below.

Nurses Application Form

PERSONAL DETAILS

Various Information

PROFESSIONAL EDUCATION AND TRANING.

Please select the Nursing Specialities of which you have significant post training experience. (Medical, Learning Disability, ITU Psychiatric, Intensive Care Unit, In charge Duties, Hospitals, Hospices, Home Care, High dependency Unit, Health Visitors, Haematology, Gynaecology, GU Med, Dental, District Nursing, Family planning, Urology, Mental Health, Stoma Care, Theatre, Renal, Residential Homes, Paediatric, Oncology, Midwifery, Nursing Homes, Out patients, CSSD, Neonatal, Care of the elderly, Practice Nurse, Recovery, Prisons, Surgical, Occupational Health, Mental health, Orthopaedics, PICU, SCBU, A & E, Cardiac, ODP /ODA, Neurology, Radiology, Scrub, Theatre, Day Surgery, Intensive Care Unit, Day Care Centre, School Nurse, Ante Natal, Cardiothoracic, Chemotherapy, Anaesthetic Trained, Medical Assess unit) Please remember you will be held accountable for any missing information

MID WIVES ONLY.

EMPLOYMENT HISTORY.

Please give details of your past 5 years of continuos work history giving reason(s) for any breaks in employment

First Employer.

Second Employer.

HEALTH DECLARATION.

Have you been vaccinated or tested against the following? (Hepatitis B, HIV, Tetanus, Poliomyelitis, Typhoid, Rubella (German Measles), Tuberculosis and BCG, Hepatitis B Antibodies, Mantoux - tine or Heaf, Varicella, Last X-ray, Others (Specify) If yes, fill below).

Do you or have you at anytime suffered from any of the following? (Skin complaints- dermatitis, Psoriasis, Eczema Diabetes or glandular complaints, Headaches or Migraine, Hypertension/ heart problems/ similar illness, Back pains / Back injury or problems, Jaundice / Hepatitis, Epilepsy or fainting attacks, Pleurisy /Bronchitis / Pneumonia, Asthma, Infections - ear / sore throat, Psychiatric illness – Mental disorder/ depression etc )

If you do not have vaccination information, please provide details of where we can request them below

I certify the above information is correct and hereby give permission to Solutions Healthcare Services to request a further report from my GP/ Occupational Health/ Hospital for clarifaction if required and for my health report.

WORK PREFERENCE.

What kind of Nursing Work are you interested in? (Fill yes, in all that apply)

Please indicate when you would like to work.

Avaliability

REHABILITATION OF OFFENDERS ACT 1974.

Because of the nature of the work for which you are applying, this post is exempt from the provisions of section 4.2 Rehabilitation of Offenders Act 1974 (Exemption Order 1975). Applicants are therefore, entitled to withhold information about convictions, which for other purposes are 'spent' under the provision of the Act in the event of employment, any failure to disclose such convictions could result in dismissal or disciplinary action. Information provided will be kept confidential and use in relationship to the post applied for.

Have you ever been convicted of a criminal offence?

Do you have any spent or unspent convictions?

Have you instigated an enhanced disclosure within the last six years?

I CONSENT TO MY NURSING AGENCY CHECKING THE DETAILS I HAVE PROVIDED AGAINST THE VARIOUS DATA SOURCES IN ORDER TO VERIFY MY IDENTITY AND PROCESS THIS APPLICATION.. THESE DETAILS MAYBE USE TO ASSIST OTHER ORGANISATION SUCH AS CRB, NMC IN IDENTITY PURPOSES.

REFERENCES.

Please give the names and addresses of two of most recent employers with work addresses who is able to comment on your work ability and experience. starting with your present to most recent employer if possible.

Reference A

Reference B

BUILDING SOCIETY /BANK DETAILS

I authorise Solutions Healthcare to pay my weekly wages into the above bank account and I will notify My Nursing Agency if changes occur to my details

NEXT OF KIN

WORKING TIME REGULATIONS

I have read and understood the Working Time Regulations and I hereby consent that the working time limit shall not apply to my assignments

FINAL STATEMENT

I declare that the information provided on this application is true to the best of my knowledge. I have read the terms and condition of engagement and agree to comply with the current Health and Safety at Work Act. I understand that my appointment is subject to the receipt of two satisfactory references and it subject to Enhanced CRB Disclosure. My Nursing Agency is free to make any other enquiries thy may find necessary relating to my application. I agree to respect the confidentiality of patients and clients and any other information I may have access to.