CASTLE MERCY HEALTHCARE SERVICES

APPLICATION/REGISTRATION FORM

Application/Registration Form

* Indicated fields must be completed

SECTION 1 : Personal Details

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Proof of Address

Please upload 2 (two) items stating your full name and current home address- Accepted Documents – A utility bill (gas, electric, satellite television, – Landline phone bill) issued within the last three months – Local authority council tax bill for the current council tax year – Bank, Building Society statement (last three months) – Original mortgage statement from a recognised lender issued for the last full year – HMRC correspondence within the current financial year (e.g. P45 / P60, self-assessment letter, tax demand, etc.)
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Accepted file types: pdf, doc, docx, jpg / Max. file size: 5 MB.
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Accepted file types: pdf, doc, docx, jpg / Max. file size: 5 MB.

SECTION 2 : Rehabilitation of Offenders Act

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SECTION 3 : Health

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SECTION 4 : Education

Education and Training

Please list your qualifications in reverse order, starting with the most recent first. Also, include any training that you have received which did not lead to a qualification but which you feel is relevant to the post. If short-listed for an interview, please be prepared to bring original copies of any certificates relating to post-school qualifications or vocational qualifications.
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Other Qualifications

Please give details of any other qualifications obtained or relevant courses attended.
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SECTION 5 : Employment Record

Please list chronologically, starting with current or last employer
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SECTION 6 : Reference

Please give the names and addresses of your two most recent employers (if applicable). If you are unable to do this, please clearly outline who your referees are.
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The second referee can be your present employer or character reference (We will accept personal friends – No relatives.)
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SECTION 7 : Emergency Contacts

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SECTION 8 : Personal Attributes

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SECTION 9 : Declaration

I confirm that the information provided in this application (and within my Curriculum Vitae if applicable) is both truthful and accurate. I have omitted no facts that could affect my employment. I understand that any false misleading statements could place any subsequent employment in jeopardy. I understand that any employment entered into is subject to documentary evidence of my right to work in the UK and satisfactory references. I expressly consent to personal data contained within this form being recorded for the purposes of assessing suitability for the post and may form the basis of any subsequent personnel file.
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Enter Fullname as signature proof
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Castle Mercy Healthcare Services ltd undertakes that it will treat any personal information that you provide to us, or that we obtain from you, in accordance with the requirements of the Data Protection Act 1998. After initial assessment, Castle Mercy Healthcare Services may keep your details on file for opportunities that may arise in the future. Please tick if you do not wish us to hold your details.*
Accepted file types: pdf, doc, docx, jpg / Max. file size: 5 MB.

SECTION 10 : Recruitment Monitoring Form

This sheet will be separated from your application form upon receipt and does not form part of the selection process. It will be retained by Human Resources purely for monitoring purposes.

Application for the post of:

To help us ensure that our Equal Opportunities Policy is fully and fairly implemented please COMPLETE THIS SECTION OF THE APPLICATION FORM.
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Asylum and Immigration Act 1996:

It is now a requirement that before any offer of employment can be made, all candidates are to provide confirmation of their eligibility to work in the UK. Please bring one of the following original documents with you if invited to interview: a passport or an immigration and nationality directorate application registration card which evidence the right to work in the UK or a UK residence permit issued to an EEA national which confirms right of entry to or residence in the UK.