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Personal Information
Select Preferred Position
Registered Nurse
Healthcare Assistant
Senior Carer
Support Worker
Domestic Duties
Project Manager
Project Co-Ordinator
Bid and Tender Consultant
Business Manager
Business Co-Ordinator
IT/Web Design
Placement
Full Names
Mr.
Mrs.
Miss.
Dr.
Prof.
Rev.
Date Of Birth
Address
Let Us Reach You
Extras
Do you have a passport?
Yes
No
Which passport do you hold ?
British Passport
EU Passport
Non-European/British Passport
Upload passport data page here
Accepted file types: jpeg, png, pdf, Max file size: 5mb
Upload Biometric Residence Permit(BRP)
Accepted file types: jpeg, png, pdf, Max file size: 5mb
Upload Working Permit/Biometric Back
Accepted file types: jpeg, png, pdf, Max file size: 5mb
Do you have a full driving license?
Yes
No
Upload your full driving license here
Accepted file types: jpeg, png, pdf, Max file size: 5mb
Do you have your own vehicle for work ?
Yes
No
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Qualifications
Are you on A COS? *
Yes
No
Do you have a DBS Certificate? *
Yes
No
Do you have a Care Certificate? *
Yes
No
Upload your CV
Accepted files: jpg, gif, pdf, png
Upload Your Care Certificate
Accepted files: jpg, gif, pdf, png
Upload Your DBS Certificate
Accepted files: jpg, gif, pdf, png
Education
Examinations/Qualifications
Date Obtained
Further Education
Examinations/Qualifications
Courses Taken
Date Obtained
Further Qualifications & Training
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Previous Employment History
Please give a job description of your present/last job and your responsibilities
Company Name
Address
Start Date
End Date
Job Title
Reason For Leaving
Type Of Business
Salary
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Next Of Kin Details *
Full Names
Mr.
Mrs.
Miss.
Dr.
Prof.
Rev.
Address
Contact Info
Supporting Information
Describe the particular skills and abilities you possess which illustrate your suitability for this post giving examples where appropriate. State briefly why you are interested in this post and how you see yourself fulfilling this role.
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Employment References *
Full Names
Mr.
Mrs.
Miss.
Dr.
Prof.
Rev.
Address
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Protecting Children and Vulnerable Adults
The following information may be required if the post you are applying for has a requirement for a DBS police check
Enhanced Checks Only
Are you aware of any police enquires undertaken following allegations made against you which may have a bearing for your suitability for this post ?
Yes
No
Disability Discrimination Act
This act protects people with disabilities from unlawful discrimination. We actively encourage applications from people with disabilities. The Disability Discrimination Act defines a disability as a physical and mental impairment which has a substantial and adverse long term effect on their ability to carry out day to day activities
Do you have a disability which is relevant to your application ?
Yes
No
We will try to provide access equipment or other practical support to ensure that people with disabilities can compete with non-disabled people
Do we need to make any specific arrangements in order for you to attend the interview ?
Yes
No
Health
In line with educational health requirements, Kemhealthcare and consulting Ltd needs to ensure that all members are protected against or immune to certain diseases. Please provide details of current vaccination statuses (Proof will be required). Your health status is important to us. Please indicate below.
Vaccination
Select if applicable to you
COVID-19
Recruitment Monitoring Form
This sheet will be separated from your form upon receipt and does not form part of the selection process. It will be retained by Kemhealthcare simply for monitoring purposes
Select Preferred Position
Registered Nurse
Healthcare Assistant
Senior Carer
Support Worker
Domestic Duties
To help us ensure that our Equal Opportunities Policy is fully and fairly implemented( AND FOR NO OTHER REASON) please complete this section of the application form
Black British
Black Carribean
Black African
Other Black Background
White Uk
Irish
White Non-Uk
Other White Background
White and Black Carribean
White and Black African
White and Asian
Other Mixed Background
Indian
Pakistani
Bangladeshi
Other Asian Background
Chinese
Viatnemese
Other Ethnic Background
Declaration
DISCLOSURE AND BARRING SERVICE CHECK: A disclosure and barring service check will be requested in the event of you being offered the post. If you register with DBS Update Checking Service, your DBS will be checked as and when required
SECURITY CHECK DISCLAIMER/ CONSENT
A security check will be performed in the event of you being offered the post
REHABILITATION OF OFFENDERS ACT 1974
Because of the nature of the work you are applying for, this post exempted from the provision of section 4(2) of the rehabilitation of offenders Act 1974(Exception) order 1975. Applicants are therefore not entitled to withhold any information about convictions which for other purposes are "spent" under the provision of the Act and in the event of employment, any failure to disclose such conviction could result in dismissal from the company. Any information given will be completely confidential and will be considered only in relation to an application for the position to which the order applies.
Supporting Documents
Please select and upload all documents
Passport Sized Photograph
Proof of Right to Work(if applicable)
Tuberculosis Test Certificate
Proof of Address
Upload your passport here
Upload your Tuberculosis Certificate here
Upload your proof of address 1 here
Upload your proof of address 2 here
Upload your Right To Work here
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