Nightingale's Care Application Form

Application for the post of: REGISTERED NURSE / CARE ASSISTANT

Select a job to apply for *Care AssistantRegistered Nurse

PLEASE NOTE: Due to the nature of our business, we can only consider applicants with a full driving licence and their own transport.

Registered Nurses are required to have a minimum of six months' clinical experience within the past two years which can be supported by a suitable referee. Care Assistants are required to have a minimum of six months' care work experience.

Section 1: Personal Details

Title * Forename(s) * Surname * Date of birth * Nationality Address line 1 * Address line 2 Address line 3 Postcode * Tel. no Mobile no. Ni number Email address *

Section 2: Current Employment

Name Date employment began Job held

Address line 1 Address line 2 Address line 3 Postcode

Brief description of duties If applicable, period of notice required

From

To

Duties Reason for leaving

From

To

Duties Reason for leaving

From

To

Duties Reason for leaving

This post is exempt from Section 4(2) of the Rehabilitation of Offenders Act 1974 (Exemptions) (Amendment) Order 1986. It is not, therefore, in any way contrary to the Act to reveal any conviction(s) which would otherwise be considered as 'spent'.

Please indicate if you have any criminal convictions and give dates and any relevant details

Section 4: Qualifications

Please list relevant courses undertaken and give dates

Section 5: Computer Literacy

Section 6: Work Availability

Please indicate below the approximate number of hours available per week and times preferred.

Number of hours

Section 7: Work Preferences

Please indicate in which of the following areas you would prefer to work:

Section 8: References

Please nominate two referees. If in employment, one referee should be your present or immediate past employer. A character reference should be someone who has known you for 3 - 5 years. No family members are allowed to give you a character reference.

Name Position

Address line 1 Address line 2 Address line 3 Postcode

Name

Address line 1 Address line 2 Address line 3 Postcode

Section 9: Any Additional Information

Additional information

Middle Name