APPLICATION FORM

Position applying for: *

Title *

Full name (including middle names): *

Do you have an experience within the role you are applying for? *

Full address (including postcode): *

Email: *

Mobile No: *

Is the mobile number above linked to your WhatsApp account? *

If no, please enter your WhatsApp number below: *

National Insurance No: *

Upload valid ID (passport, birth certificate, valid UK driving licence): *

Max file size: 20MB

Upload your valid Right to work document: *

Max file size: 20MB

Do you consent PH Staffing to check your immigration status online, if so, please enter your immigration status share code below: *

Upload proof of your address (utility bill or bank statement no older than 3 months, driving licence): *

Max file size: 20MB

Upload proof of your bank details (Bank account opening letter, bank statement no older than 3 months) *

Max file size: 20MB

Upload your up to date CV (EXPLAIN ANY EMPLOYMENT GAPS) *

Max file size: 20MB

Next of kin contact details (relationship to you, full name, mobile number, email address): *

Do you hold valid UK driving licence? *

Availability to the car? *

Have you been convicted of a criminal offence or received a caution, warning or reprimand? *

Upload proof of your NI number (NI letter, payslip, P60: *

Max file size: 20MB

Upload good quality passport size photo of you: *

Max file size: 20MB

Upload your valid driving licence (if applicable): *

Max file size: 20MB

If yes, please provide the date: *

Is your DBS registered with the DBS Update Service? *

Do you give consent to PH Staffing to check your DBS certificate online? *

Please enter your DBS certificate number and issue date (if applicable): *

Please tick each task in which you are experienced. Personal hygiene: *

Nutrition: *

Preparing meals Assisting with meal Food handling Food presentation

Medication: *

Level 1 Prompt/Assist Level 2 Administer Level 3 Administer using specialist techniques Instillation of eye, nose and eardrops

Continence Management: *

Continence care Bedpans/commodes etc. Changing a catheter bag Stoma care

Mobility: *

Lifting and handling Use of hoist (manual/electric) Support with walking aids Moving of service users

Administrative Abilities: *

Report writing Recording instructions from GP/nurse Recording changes in service user’s condition

Other, please specify: *

Working Times Regulations Declaration. DO you wish to work more than 48 hours per week? By saying YES you Opt-out from of the 48-hour weekly limit. *

Employment reference 1 (Name of the company, Referee's full name, professional relationship to you, telephone No, email address): *

Employment reference 2 (Name of the company, Referee's full name, professional relationship to you, telephone No, email address): *

PH STAFFING