Application form

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

1Your Personal Details

2Employment & Education

3Skills & Training

4Declaration & Terms

EDUCATION & EMPLOYMENT HISTORY
Please ensure you complete this section even if you have a CV. The NHS states that “Employment history should be recorded on an Application Form which is signed” 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 Salary on leaving
Education
Please supply documentary evidence.
Education*
Institution Course Year Grade
Upload CV if you have one.
Accepted file types: jpg, gif, png, pdf, jpeg, docx, Max. file size: 128 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. By entering the referees' details, you give us permission to contact them.
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
Are you happy for us to send a reference request email to both of the above referees upon your submission of this application form?*
- Yes
- No

Declaration of Fitness to Work
Declaration of Fitness to Work*
- I declare that I am fit to work and able to perform the essential functions of the position for which I am applying. I confirm that I have no health issues that would prevent me from fulfilling my duties effectively.
Declaration of Fitness to Work*
- I understand the importance of notifying Nexime Healthcare regarding any changes in my health status that may affect my employment.
Confidentiality Agreement, Security Checks, and Disclaimer for Temporary Workers at Nexime Healthcare LTD
Confidentiality Agreement:

1. Purpose:
The purpose of this agreement is to ensure the protection and privacy of confidential information that employees may access while working at Nexime Healthcare LTD ("the Company").

2. Definition of Confidential Information:
"Confidential Information" includes, but is not limited to, patient records, business strategies, financial data, proprietary information, and any other data designated as confidential by the Company.

3. Obligation:
Under the Data Protection Act 2018, you are required to protect all Confidential Information accessed during your employment. Disclosing or using this information outside your professional duties is strictly prohibited.

4. Duration:
This confidentiality obligation continues after the termination of your placement with the Company, for a period of five years, unless otherwise required by law.

5. Consequences:
Breach of this confidentiality agreement may result in disciplinary action, including potential termination and/or legal action by the Company.

Security Checks:

1. Background Verification:
As part of our pre-employment process, you consent to necessary background checks which may include verification of previous employment, right to work in the UK, criminal records, and other relevant screenings.

2. Access Control:
You will be provided with identification and access credentials which are personal and non-transferable. Any loss or theft must be reported immediately to the Company.

3. Digital Security:
Compliance with the Company’s IT security policies is required, including proper password management, data encryption, and secure system access.

Disclaimer:

1. Work Limitations:
Your role, duties, and responsibilities will be clearly outlined in your assignment letter or contract. You must conduct all duties in accordance with health and safety standards and employment laws within the UK.

2. No Employment Assurance:
This agreement does not constitute a promise of continued employment or conversion to a permanent role. Employment is subject to current Company needs and UK employment laws governing temporary work.

3. Legal Compliance:
You are expected to comply with all Company policies, operational guidelines, and legal obligations, including the Health and Safety at Work etc. Act 1974 and the General Data Protection Regulation (GDPR) as it applies within the UK.
Acknowledgement*
- I hereby acknowledge that I have read, understood, and agree to abide by the terms outlined in this Confidentiality Agreement, Security Checks, and Disclaimer policy.
GDPR Consent
Consent for Data Sharing and Processing
Purpose: This consent form is required to comply with our contracts with clients, regarding the sharing and processing of personal data.

Please read the statements below and indicate your consent by checking the appropriate box:
Consent for Data Sharing*
I consent to my personal data being made available to authorized third parties in order to comply with current regulations and for the purposes of auditing.
- I consent
- I do not consent
Objection to Data Usage*
I have no objection to my details being held on computer records and utilised by the company in pursuit of its legitimate business.
- I have no objection
- I have objection
Today's Date*
DD slash MM slash YYYY
Full Name:*
Signature*

Employer	Position	Duties	Date From - To	Salary on leaving

Institution	Course	Year	Grade

Application Form

Personal Details 1

Address

Personal Details 2

Employment Eligibility

Driving Details

Next of kin details

Your Work Preference

EDUCATION & EMPLOYMENT HISTORY

Education

REFERENCES

Reference 1

Reference 2

SKILLS, EXPERIENCE & TRAINING

Mandatory Training

Other Training/Courses & Qualifications

APRAISALS

YOUR DBS STATUS & UNIFORM

DBS Status

Uniform

HEALTH DECLARATIONS

Health Declaration

GP Details

MEDICAL HISTORY

Tuberculosis

Chicken Pox or Shingles

Immunisation History

Exposure Prone Procedures

Declaration

Disclosure Barring Service (DBS)

Rehabilitation of Offenders Act 1974 and Criminal Records

Right To Work

Work Time Directives

Registration form Declaration

Declaration of Fitness to Work

Confidentiality Agreement, Security Checks, and Disclaimer for Temporary Workers at Nexime Healthcare LTD

GDPR Consent

Office Address

Contact Information

Opening Hours

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