Staff Nurse - HDU(Ref: HDU58)

Personal Details (1/6)

Surname:
First Names:
Known As:
Address 1:
Address 2:
Town/City:
Postcode:
Contact Number:
Alternative Number:
Email Address:
Do you require a work permit?
Yes     No
Do you hold a current driving licence?
Yes     No
Are you a car owner?
Yes     No
National Insurance Number:
Additional Comments:
Nursing/Health Professions Council registration details
Body (NMC/HPC):
Pin/Registration Number:
Expiry date:
Membership of professional body
Body:
Registration Number:

Your Application (2/6)

Application for the post of:
At which facility:
How did you become aware of the vacancy?:
Are you seeking:
Full Time     Part Time
Are you fully flexible in your working days/hours/pattern:
Yes     No
If "No", please provide details:
What is your notice period?:
What date are you able to start work from::
Please confirm your interview availability:
Do you know anyone who currently works for Aspen Healthcare?
Yes     No
If "Yes", who?:
Have you applied to work for Aspen Healthcare before?
Yes     No
If "Yes", please provide details:
Have you ever worked for Aspen Healthcare before?:
Yes     No
If "Yes", please provide details:

Education & Qualifications (2/6)

Please list your schools, colleges & universities:
Dates
Name of school/college/university
Qualifications/grade obtained
Dates
Name of school/college/university
Qualifications/grade obtained
Dates
Name of school/college/university
Qualifications/grade obtained
Dates
Name of school/college/university
Qualifications/grade obtained
Dates
Name of school/college/university
Qualifications/grade obtained
Dates
Name of school/college/university
Qualifications/grade obtained
If you have attended training courses relevant to the post you are applying for, please provide details:
Dates
Name of training provider
Name of course attended
Dates
Name of training provider
Name of course attended
Dates
Name of training provider
Name of course attended
Dates
Name of training provider
Name of course attended
Dates
Name of training provider
Name of course attended
Dates
Name of training provider
Name of course attended
Do you know any foreign languages?
Yes     No
If "Yes"; please provide details of the language and level of proficiency:

Employment (3/6)

Present/most recent employer

Company Name:
Website:
Position Held:
Line manager's name:
Start date:
Leaving Date:
Salary:
Address 1:
Address 2:
Town/City:
Postcode:
Please give a brief description of your current duties and responsibilities
Reason for leaving or wanting to leave:

Previous Employer

Company Name:
Website:
Position Held:
Line manager's name:
Start date:
Leaving Date:
Salary:
Address 1:
Address 2:
Town/City:
Postcode:
Please give a brief description of your current duties and responsibilities
Reason for leaving or wanting to leave:

Previous Employer

Company Name:
Website:
Position Held:
Line manager's name:
Start date:
Leaving Date:
Salary:
Address 1:
Address 3:
Town/City:
Postcode:
Please give a brief description of your current duties and responsibilities
Reason for leaving or wanting to leave:

Previous Employer

Company Name:
Website:
Position Held:
Line manager's name:
Start date:
Leaving Date:
Salary:
Address 1:
Address 3:
Town/City:
Postcode:
Please give a brief description of your current duties and responsibilities
Reason for leaving or wanting to leave:

Previous Employer

Company Name:
Website:
Position Held:
Line manager's name:
Start date:
Leaving Date:
Salary:
Address 1:
Address 3:
Town/City:
Postcode:
Please give a brief description of your current duties and responsibilities
Reason for leaving or wanting to leave:

Previous Employer

Company Name:
Website:
Position Held:
Line manager's name:
Start date:
Leaving Date:
Salary:
Address 1:
Address 3:
Town/City:
Postcode:
Please give a brief description of your current duties and responsibilities
Reason for leaving or wanting to leave:
*Professional Referees

Additional Information

Where there are gaps in your employment history, please provide full details here including dates:

Aspen Healthcare's values (4/6)

Our employess are encouraged to embrace our values in everything they do.

  • Beyond Compliance
  • Personalised Attention
  • Partnership & Teamwork
  • Investing in Excellence
  • Always with Integrity
In no more than 500 words, describe how you would demonstrate our values in the workplace for the position you are applying for:

Referees (5/6)

Please provide your referee details covering at least the last 5 years. This must include your current/most recent employer. Where there are breaks in your employment please provide details of a personal referee*.

Do you consent to references being obtained prior to interview?:
Yes     No
Referee Number 1
Name
Occupation/
Relationship:
Address 1:
Address 2:
Town/City:
Postcode:
Telephone Number:
Email Address:
How long have you known this referee?:
Referee Number 2
Name
Occupation/
Relationship:
Address 1:
Address 2:
Town/City:
Postcode:
Telephone Number:
Email Address:
How long have you known this referee?:

*Professional Referees (where applicable)

Referee Number 1
Name
Occupation/
Relationship:
Address 1:
Address 2:
Town/City:
Postcode:
Telephone Number:
Email Address:
How long have you known this referee?:
Referee Number 2
Name
Occupation/
Relationship:
Address 1:
Address 2:
Town/City:
Postcode:
Telephone Number:
Email Address:
How long have you known this referee?:

Disclosure (4/6)

Have you ever been (or are you currently) the subject of any police investigation or conviction in this or any other country?:
Yes     No
Have you ever been (or are you currently) the subject of fitness to practice proceedings by any licencing or regulatory body?:
Yes     No
Additional Information
Rehabilitation of Offenders Act 1974/strong>

Because of the nature of the work for which you are applying, this post is exempt from the provisions of Section 4 (2) of the Rehabilitation of Offenders Act 1974 by virtue of the Rehabilitation of Offenders Act 1974 (Exemptions) Orders 1975. Applicants are therefore not entitled to withhold information about convictions which for other purposes are 'spent' under the provisions of the Act, and, in the event of employment, any failure to disclose such convictions could result in dismissal or disciplinary action by the management of Aspen Healthcare Ltd. Any information given will be completely confidential.

Additional Information
Where needed, please use this section to provide additional information
Declaration

I understand that appointment, if offered, will be subject to the information given on this form being correct and that failure to disclose accurate information will disqualify me from consideration as will my failure to disclose pertinent facts relating to my previous employment. I also understand that my appointment is subject to a satisfactory pre-employment medical assessment, DBS/Disclosure Scotland check and satisfactory references.

Aspen Healthcare Ltd is an equal oppertunities employer and as an employee, you will be required to pursue your duties in accordance with its Equal Opportunities Policy.

You are required to acknowledge by signing below your agreement and understanding of these statements.

Applicants Signature:
Date:

Equality Opportunities Recruitment (6/6)

Equality opportunity recruiment monitoring form - Confidential

Aspen Healthcare Ltd is committed to promoting equality, diversity and an inclusive and supportive environment for all prospective employees.

In particular, Aspen Healthcare Ltd will seek to ensure that people are treated equitably regardless of their gender, race, colour or national origins, age, disability, socio-economic background, religious or political beliefs and affiliations, marital status, family responsibilities, sexual orientation or other inappropriate distinction.

In order to monitor the impact of this policy it is necessary to collect information from all employees and job applications on the key characteristics, which relate to equality and diversity in employment.

The information collected will be used for monitoring purposes and to update our confidential recruitment and employee database under the terms of the Data Protection Act 1998. The information will be used to form baseline statistical reports to assess the impact of our policy and promote equality of opportunity.

Personal Details
Date of birth:
Do you consider yourself to have a disability?
Yes    No
If 'yes' what is your disability?
The Act defines a disability as "a physical or mental impairment which has a substantial long term and adverse effect on a person's ability to carry out normal day-to-day activities".
Nationality
Please specify:
Ethnicity -  What is your ethnic background?
White
British  
Irish  
Mixed
White & Black Caribean  
White & Black African  
White & Asian  
Asian or Asian British
Indian  
Pakistani  
Bangladeshi  
Black or Black British
Caribbean  
African  
Chinese or other ethnic group
Chinese  
Religion
What is your religous belief?
Christian
Buddhist
Hindu
Jewish
Muslim
Sikh
Gender
What is your sex?
Female
Male
Sexual Orientation
What is your sexual orientation?
Lesbian or Gay    
Bisexual  
Heterosexual  
Prefer not to say
CV
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Covering letter:

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