Personal Details

PayRoll Information

Limited Company's
N.B Certificates of registration will be required. If you require to be paid through a UK limited or corporate company then the following details are required:

Employment History

Employer 1:

Employer 2:

Employer 3:

Education And Qualifications

Education 1:

Education 2:

Education 3:

References

Please note that for both temporary and permanent positions we will need to obtain a minimum of 2 satisfactory references. Please provide a minimum of two referees we may approach (one of which must be an employment reference. References must cover you for a minimum of 3 years employment) These referees will help us find you suitable employment. We will not contact your current employer without your consent.

Reference 1:

Reference 2:

Criminal Records & Security Checks

Have you ever been convicted of a criminal offence?
The amendments to the Exceptions Order 1975 (20 13) provide that certain spent Convictions and cautions are ‘protected’ and are not subject to disclosure to employers, And cannot be taken into account.. Guidance and criteria on the filtering of these Cautions and convictions can be found on the Disclosure and Barring Services website).
YesNo

You may be offered an opportunity to work within an Environment or establishment where you come into contact with children or other vulnerable groups, or your professional occupation may fall within certain expected categories where this is likely to apply, (The amendments to the Exceptions Order 1975 (2013) provide that certain spent Convictions and cautions are ‘protected’ and are not subject to disclosure to employers, And cannot be taken into account.. Guidance and criteria on the filtering of these Cautions and convictions can be found on the Disclosure and Barring Services website).
YesNo

Do you hold a criminal record bureau disclosure or overseas police check carried out within the last 3 years?
YesNo

Do you hold any form of security clearance?
YesNo

Please note you will be required to obtain a CRB disclosure through Impress Recruitment Services, so please ensure all information is correct. Any false information given could result in suspension and in more severe cases this matter could be taken further.

Why do you think you are suitable for this job role?

Health and Safety

Do you suffer from or have you ever suffered from any of the following?

Heart Problems/ Hypertension/ Circulatory Illness
YesNo

High or Low blood pressure
YesNo

Diabetes
YesNo

Asthma/ Hay fever
YesNo

Bronchitis/ Pneumonia/ Pleurisy
YesNo

Epilepsy/ Fainting attacks/ Black Outs/ Fits/ Sudden Collapse
YesNo

Headaches/ Migraines
YesNo

Dermatitis/ Skin Sensitivity/ Psoriasis/ Eczema/ Allergies
YesNo

Eyesight problems not correct by glasses or contact lenses
YesNo

Hearing Problems
YesNo

Chest Pains or Shortness of breath
YesNo

Mental illness (psychological or psychiatric)
YesNo

Joint Pains/ swelling or stiffness
YesNo

Working on Visual Display Units?
YesNo

Any other condition
YesNo

Are you registered Disabled?
YesNo

Do you consider yourself to be disabled?
YesNo

Have you been given hospital treatment in the last 12 months?
YesNo

Have you been tested or inoculated for any of the following?

Varicella
YesNo

Tuberculosis including BCG
YesNo

Hepatitis A/ Hepatitis B
YesNo

HIV
YesNo

Nursing Additional Documentation Required

CV

NMC

DBS/CRB

Passport

RCN (Insurance)

Training certificates (all certificates including BLS, Child/Adult safeguarding)

Immunisations

References

Proof of address

Bank Details