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WDE Healthcare Application Form

WDE Recruitment are now recruiting healthcare professionals. Need assistance please call our main office on 01233 647 401 or email: wdehealthcare@gmail.com

Personal Details

Title:
Name:
Date of Birth:
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Address:
Grade:
E-mail:
Tel No (home):
Tel No (mobile):
Do you require a work permit to work in the UK?:
Revalidation Date:
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Professional Membership No (NMC Pin Number, GMC Reg No etc:
PIN Expiry Date:
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Covid Pass Number:
Please confirm you are over 18 years of age:
Skills:
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Education

Name and Location of Schools, Colleges:
Subjects Passed and Type of Examination and Grades:

Further/Higher Education (To Include Professional Awards and Qualifications)

Name of Institution (College/Polytechnic/University:
Degree/Diploma/Certificates Obtained (State Grade and Date):
Type of Course (F/T, P/T:
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Present/Last Employment

Position Held:
Name of Employer:
Employment Address:
Salary:
Nature of Business:
Date from:
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Date to:
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Reason for leaving/wishing to leave:
Brief description of duties and responsibilities:

Previous Employment (5 year work history)

Please Include
Dates From & To
Name & Location of Employer(s),
Position Held & Responsibilities,
Reason for Leaving:

Professional Indemnity

All Nurses and operation department practitioners hold valid Professional Indemnity Insurance to the value of £3m per claim.
Please indicate which organisation you are a member of and your membership number.

Organisation:
If other:
Membership No:
Renewal Date:
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Other Information

Please give any additional information to support your application, as well as any explanation you would like to provide relating to any gaps in your employment:

References

Referee Name:
Company Name:
Company Address:
Occupation:
(Ref) Tel No:
(Ref) Email:
Referee Name:(2)
Company Name: (2)
Company Address:(2)
Occupation:(2)
(Ref2) Tel No:
(Ref2) Email:
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Next of Kin Details

Next of Kin Name:
Relationship:
Next of Kin Address:
Home Telephone:
Mobile:
Can you confirm that this individual knows that you have supplied their details to us as your next of kin:
Where did you hear about us?:

Disclosure Information

Because of the nature of the work concerned, this post is exempt from the provision of section 4 (2) of the Rehabilitation of Offenders Act 1974. You are not entitled to withhold information about convictions which for other purposes are ‘spent’ under the provisions of the Act. Any such information given will be completely confidential and will be considered only in relation to your registration. In order to fulfil the requirements of the above mentioned Act would you please complete the following:

Have you been convicted of a criminal offence, been bound over, cautioned or are you currently the subject of any police investigation/actions, which might lead to a conviction, an order binding you over or a caution in the United Kingdom or any other country?:
If Yes, What date did this take place? :
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What is the charge (State details of the offence, binding overcaution) public disorder Act:
In which Authority/Country did this take place?:

Having a criminal conviction will not bar you from working with us. This will depend on the nature of the position and the circumstances and background of your offence. In the event of employment, any failure to disclose such convictions could result in disciplinary action by WDE Recruitment Ltd upto immediate termination of your terms of engagement.

Have you ever been or are you currently subject to any fitness to practice proceedings by an appropriate licensing or regulatory body in the United Kingdom or any other country?:
Country and name and address of licensing or regulatory body:
If Yes, Details of the proceedings:
Date of proceedings:
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Have you ever been disqualified from practicing?:
If YES Please give details:
Have you ever been dismissed from employment?:
If YES Please give details:

I certify that I have read the document fully and that all the above information is correct. I understand that false declaration may lead to refusal of this application. If I am convicted or plead guilty to any offence whilst with WDE Recruitment Ltd. I confirm that I will immediately supply full details of that to my manager without delay. I understand that registration is subject to an occupational health assessment, references and Disclosure and Barring service disclosure (DBS).

Digital Signature:*
Dated:*
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Information For Candidates

Your Registration


  • Completing and returning your registration form.

Your application form and any supporting documents are the only information that will be used to decide whether or not you meet the criteria to register, it is therefore important that you complete the form accurately and in full.


  • Shortlisting, references and attending interviews

If after two weeks you have not received notification that you have been allocated an interview, regretfully you are advised that your registration has been unsuccessful.


As indicated on the application form two referees are required. If you are currently employed, one should be the name of your current employer, when this represents a period of employment in excess of 3 months, and the second from appropriate individuals who can ensure the integrity and good character of yourself. Friends and family members will not be accepted.


In the event that you have only worked as a volunteer, references will be required from the two most recent bodies for whom you have worked.


  • Rehabilitation of Offenders Act 1974 and Criminal Disclosure

Criminal Disclosure is required for all applicants of WDE Recruitment prior to the completion of registration. At interview you will asked to declare any/all cautions/formal warnings, convictions or bind overs, including any which are ‘spent’ or pending which you may have. WDE Recruitment will then take a view as to how this affects your potential registration


  • Data Protection

The company will hold personal data relating to you for administration and management purposes and to comply with its legal `obligations with regard to the retention of your records. For further information on how we store and process your information please see our Privacy Notice.


  • Registration/Fitness to Practice

Applicantswith WDE Recruitment are required to disclose on the registration form and at interview whether they are the subject of any fitness practice proceedings by an appropriate licensing or regulatory body in the United Kingdom or any other country.


WDE Recruitment will then take a view as to how this disclosure affects your potential assignments.

In addition, you will be required to provide proof of valid registration and to maintain that registration throughout any subsequent employment


  • Qualifications

Where specific qualifications are required in relation to the position applied for verification will be sought at interview.


  • Conduct

All applicants for registration with WDE Recruitment are required to disclose on the registration form and at interview whether they have ever been dismissed from employment.


WDE Recruitment will then take a view as to how this disclosure affects your potential assignments.

In addition to this information will be sought from identified referees.


  • Occupational Health

A medical questionnaire will be required to be completed at only after a conditional offer has been made.


  • Work Permits

In accordance with the Asylum and Immigration Act 1996, if you are a member of the European Economic Area/European Union you are legally entitled to work in this country. If you require a work permit this documentation must be obtained before and unconditional offer of employment can be made.


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Equal Opportunities

WDE Recruitment are taking steps to ensure the implementation of its Equal Opportunities Policy. This form is intended to monitor the effectiveness of our Policy, and it would be much appreciated if you would complete and return it with the registration form. This form will play no part in the process of recruitment and it is used purely for monitoring purposes, hence it is not compulsory to complete it.

Grade registered for:
Ethnic Origin:
If Other please specify:
Disability:
Gender:
Marital Status:
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48 Hour Opt- Out Agreement

The Working Time Regulations Act 1998 requires WDE Recruitment Ltd to limit your average weekly working time unless you agree with WDE Recruitment that the limit shall not apply to you. WDE Recruitment wishes to have that agreement with you.

It proposes an arrangement (which will apply until terminated by notice) on the basis that

You may terminate the agreement (so that the time limit would apply to you) by giving WDE Recruitment four weeks written notice.

Under the Regulations WDE Recruitment Ltd must keep records relating to your working time. This is the case whether or not you reach an agreement with WDE Recruitment about waiving working time limits.

If you accept WDE Recruitments proposal, please sign below. This document will then be the record of agreement between you and the company.

Digital Signature*
National Insurance Number:*
Signed Date:*
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Confidentiality Statement


Clients of WDE Recruitment Ltd have a right to privacy and confidentiality and this must be safe-guarded at all times. Upon accepting an appointment with WDE Recruitment you may not, without the prior consent of a Director or Manager, disclose, or enable anyone to become aware of, any information or documents concerning the Client which are obtained as a result of your professional relationship with the Client.


In addition, you may not disclose any information or documents concerning the business of WDE Recruitment Ltd which are obtained as a result of your employment with WDE Recruitment Ltd


This restriction shall not apply to information coming into the public domain by other means. Any breach of this Confidentiality Agreement will be considered as gross misconduct and may make you liable to instant termination of your terms of engagement.


I have read and understood the above Confidentiality Statement

(CS) Digital Signature:*
(CS) Signed Date:*
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Healthcare Terms of Engagement Temporary Workers: Click to download

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