Registration Portal

CV Form

Fill in the form below, upload your CV and a member of the team will contact you shortly.

Name:

Phone:

Email:

CV Upload:

Welcome to our Registration Portal

Dear Candidate,

Thank you for choosing to register with Hands-On Healthcare Recruitment Ltd.

Along with your completed application forms, the documents below are also required to process your registration.

Please ensure that you are able to provide original documents for inspection at your in-person interview.

If you are unable to bring any of the listed items, you must notify us ahead of your interview. Failure to bring all of the above documents may result in the interview being rearranged or cancelled.

Your right to work in the UK documents and paperwork

2 x documents showing proof of address, dated within 3 months

Proof of your national insurance number

Your driving licence if applicable

Any relevant qualification certificates

Any relevant (recent) training certificates

Your current DBS certificate and update service information if applicable

2 x passport-sized photographs

Certificates of immunisation(s) if applicable

Nurses only: Evidence of NMC Pin (statement of Entry)

Section 1 Personal Details

Name:

Place of Birth:

	D	D	M	M	Y	Y	Y	Y
Date of Birth	Date of Birth, D:	Date of Birth, D:	Date of Birth, M:	Date of Birth, M:	Date of Birth, Y:	Date of Birth, Y:	Date of Birth, Y:	Date of Birth, Y:

Address:

Country:

City:

Postcode:

Gender:

Male

Female

Other

Postion:

Full Time

Part Time

Email:

Home Number:

Mobile Number:

Languages Spoken:

Driving Licence:

Yes

Vehicle Type:

Next of Kin Address (Must be a UK address):

Emergency Number:

Relationship:

Section 2 Security and right to work in the UK

Eligible to work in the United Kingdom?

Yes

National Insurance Number:

Do you require a visa to work in the United Kingdom?

Yes

If yes, what type of visa do you hold?

Do you have any spent or unspent criminal convictions?

Yes

Due to the nature of our business, you are required to submit a DBS check.

Do you agree for an enhanced DBS check to be carried out?

Yes

Are you currently under any criminal investigation and/or do you have any previous convictions including any cautions, reprimands, final warnings, bind-overs or any convictions from overseas that are not ‘protected’ under the Rehabilitation or Offenders Act 1974 (Exceptions) Order 1975, as amended in 2013?

Yes

Please give details below:

Failure to declare a conviction may require us to exclude you from our register or terminate an assignment if the offence is not declared but later comes to light.

Section 3 Education, Qualifications and Training

Education History

	Year	College / School name and location	Course Title	Result
1	1, Year:	1, College / School name and location:	1, Course Title:	1, Result:
2	2, Year:	2, College / School name and location:	2, Course Title:	2, Result:
3	3, Year:	3, College / School name and location:	3, Course Title:	3, Result:
4	4, Year:	4, College / School name and location:	4, Course Title:	4, Result:
5	5, Year:	5, College / School name and location:	5, Course Title:	5, Result:

Training History

	Year	Course Title	Other Details
1	1, Year:	1, Course Title:	1, Other Details:
2	2, Year:	2, Course Title:	2, Other Details:
3	3, Year:	3, Course Title:	3, Other Details:
4	4, Year:	4, Course Title:	4, Other Details:
5	5, Year:	5, Course Title:	5, Other Details:

Professional Registrations

(All professional memberships will be verified with the relevant professional body)

	Profession (e.g. Nurse)	Registration Number / PIN	Type e.g. NMC	Expiry Date
1	1, Profession (e.g. Nurse):	1, Registration Number / PIN:	1, Type e.g. NMC:	1, Expiry Date:
2	2, Profession (e.g. Nurse):	2, Registration Number / PIN:	2, Type e.g. NMC:	2, Expiry Date:

Section 4 Employment and References

Employment History

Date from:

To:

Position:

Company name:

City and County:

Reason for leaving:

Responsibilities:

Date from:

To:

Position:

Company name:

City and County:

Reason for leaving:

Responsibilities:

Date from:

To:

Position:

Company name:

City and County:

Reason for leaving:

Responsibilities:

References

Please supply the names and contact details for a minimum of two references. One of these must be from your current or most recent place of employment. References will only be accepted from your direct line manager or HR department.

	Name	Address	Business	Phone number
1	1, Name:	1, Address:	1, Business:	1, Phone number:
2	2, Name:	2, Address:	2, Business:	2, Phone number:
3	3, Name:	3, Address:	3, Business:	3, Phone number:
4	4, Name:	4, Address:	4, Business:	4, Phone number:

Section 5 Equal Opportunities

Hands-On & City Force Healthcare Recruitment is committed to a policy of equal opportunities for all work seekers and shall adhere to such a policy at all times. We will review on an ongoing basis on all aspects of recruitment to unlawful or undesirable discrimination.

Gender:

Male

Female

Other

Which ethnic group you fall into?

White:

British or Irish

Other (please specify)

Other:

Mixed:

White & Black (Caribbean)

White & Black (African)

White & Asian

Other (please specify)

Other:

Black:

Black African

Black Afro Caribbean

Other (please specify)

Other:

Other Ethnic:

Chinese

Vietnamese

Indian

Pakistani

Other (please specify)

Other:

Disability

The Disability Discrimination Act 1995 defines a person as having a disability if he/she has a Physical or Mental impairment which has a substantial and long term adverse effect on his/her ability to carry out normal day-to-day activities.

Do you have a disability as defined above?

Yes

Section 6 Misconduct Disciplinaries Investigations

Professional misconduct, disciplinary action and investigations.

Have you ever been the subject of professional misconduct proceedings or disciplinary action from an employer?

Yes

Are you aware of any investigation or grievance being undertaken by an organisation following allegations made against you?

Yes

Have you been referred to the Disclosure and Barring Service (DBS) or any other organisation or list barring you from working with children and/or vulnerable adults?

Yes

If you have answered yes to ANY of these please provide details including the name of the employer, the date, the allegation and the outcome. Where appropriate please also include the name of the licensing or regulatory body concerned.

Please confirm that you understand:

If you are caught sleeping at a shift, we will be unable to invoice the client. This means we cannot pay you for the shift.

Please confirm that you understand:

If you cancel more than 3 shifts in the first month of working with our agency, we reserve the right to disengage you from the agency.

Section 7 48 Hour Opt-in Agreement

I agree that I may work for more than an average of 48 hours per week. If I change my mind, I will provide Hands-On Healthcare / City Force Recruitment with 4 weeks’ notice in writing to end this agreement.

Confirm:

I agree

Section 8 Payment Information

Bank Name:

Branch Address:

Account Name:

Account Number:

Account Sort Code:

Name:

Confirm:

I agree to the above information

thanking you always

CV Form

Welcome to our Registration Portal