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To apply for a Care, Nurse or Homecare position in Plymouth, please complete the form below. If you have any questions, please contact us.

Healthcare Assistant Application Form
Nurse Application Form

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About you

Your Name*

First name Last name

Email*

Tel no.*

Address*

Street Address Address Line 2 City County / State / Region ZIP / Postal Code Country

NI number*

Date of birth*

DD slash MM slash YYYY

Current DBS number*

Date issued*

DD slash MM slash YYYY

Do you have a full UK driving license and access to a car?*

Yes

Level of care experience*

Over 3 Months paid experience in the care sector

Personal experience only - caring for family or a friend

No care experience

Training*

I have valid certificates I can bring in

I have valid certificates but I don't have them

I don't have any valid certificates

Emergency contact

Name*

First name Last name

Relationship*

Tel no.*

Criminal convictions

Due to the nature of the work for which you are applying, this post is exempt from the provisions of section 4.2 of the rehabilitations of offender’s act 1974 (exemption order 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. Failure to disclose such convictions could result in dismissal or disciplinary action. Any information given will be completely confidential and a criminal record will not necessarily be a bar to obtaining a position.

Do you have any spent or unspent criminal or cautions?*

Yes

Any conviction, caution, reprimand will require a written statement of each and every event and how it does not affect your suitability for the role you are applying for and we may complete a risk assessment.*

Education history

Place of study*

Courses taken/result*

Date of completion*

Place of study

Courses taken/result

Date of completion

Place of study

Courses taken/result

Date of completion

Work history

Company one*

Position*

Reason for leaving*

Dates of employment*

Company two

Position

Reason for leaving

Dates of employment

Company three

Position

Reason for leaving

Dates of employment

Company four

Position

Reason for leaving

Dates of employment

Reference one

Name*

Workplace/Position*

Email*

Tel no.*

Reference two

Name

Workplace/Position

Tel no.

Reference three

Name

Workplace/Position

Tel no.

Department of health code of conduct

The Department of Health’s Code of Conduct provides a clear guide for all those who work in social care, setting out the standards of practice and conduct of workers.

Statement of confidentiality

I understand that while working for time4care, I may have access to confidential information which must not be disclosed to any other person. Confidential information includes all information relating to the time4care, the client and its’ residents and employees. This includes not divulging any information to family and friends. If you are in doubt as to what information may be disclosed, you should check with the Branch Manager. The Data Protection Act 2018 regulates the use of computerised information and paper records of identifiable individuals (patients and staff). If you are found to have made an unauthorised disclosure you may face legal action.

Temporary worker declaration

I understand that any employer I am introduced to, either in a temporary or permanent capacity, then has a legally binding contract to pay charges should you engage in employment with them. I understand that any attempt to avoid payment of these charges may result in criminal proceedings being brought against me for fraud. I agree therefore that I cannot either apply for or accept an offer of employment with any client I have been introduced to by time4care without permission from the Manager and will advise time4care should such a situation arise.

Data protection

I consent to time4care storing data about me and that this data may be used to assist other organisations for identity verification purposes such as the DBS, regulatory bodies such as NMC, CQC or GSCC and some of the information may be shared with clients for the purposes of agreeing an assignment. time4care retains the right to hold this application and any other data required to process this application (whether in the UK, European Union or elsewhere) and keep for as long as necessary in line with the data protection act.

Working week opt-out agreement

Definitions: In this Agreement the following definitions apply: - “Assignment” means the period during which the Temporary Worker is engaged in services to a Client.
“Client” means the person, firm or corporate body that has engaged the services of the Temporary Worker.
“Employment Business” means time4care.
“Temporary Worker” means a Qualified Nurse, care assistant or other Temporary Worker.
“Working Week” means an average of 48 hours each week as calculated over any 17-week period.
TheAgreement: The Working Time Regulations of 1998 state that a Temporary Worker shall not work on an assignment with a client in excess of the Working Week unless they agree in writing that this limit should not apply and by signing the declaration below, agrees that the Working Week shall not apply to their Assignments. The Temporary Worker can end this Agreement at any time by giving the Employment Business 14 days’ notice in writing. After the 14-day notice period has expired the Working Week shall apply immediately. It should be noted, that any notice ending this Agreement does not mean that a Temporary Worker has ended an Assignment with a Client. These laws are governed by English Law and are subject to the jurisdiction of the English Courts.

Declaration agreement*

I agree

The Declaration I have read and fully understand the above Working Week Opt Out Agreement. I hereby consent that the Working Week limit shall not apply to my Assignments. I understand that I can end this Agreement by giving the Employment Business 14 days’ notice in writing.

Final declaration

I confirm that I am 18 years of age or older and am permitted to work in the UK. I have read this document fully and understand the above declarations and agreements. I have received a copy of the terms of business. I confirm that any information provided here is true to the best of my knowledge and I understand that any false or misleading information may lead to me being removed from the time4care register of temporary workers and may be a criminal offense.

Privacy notice

Time4care take your privacy seriously and will only use your personal information to process and application or to administer your assignments through us. Data processing is any handling of your data including just storing it.
We collect the information included in the application form and associated documents during the application process, details about assignments you have worked, assignment preferences and availability, pay and tax information, etc. Our legal reasons for processing your personal data include consent (you may give consent below for us to process your personal data), contract (you have asked us to find assignments for you and we need to process data to do that), legitimate interests (it is necessary in the interests of our business to do so).
This data may be shared with
• Our clients - for the purposes of arranging assignments, confirming suitability and prior training, etc
• CQC, HMRC and other agencies - in case of audit and to ensure compliance with relevant laws
• Other selected companies - such as One Less Worry Payroll Services, BrightPay, Google, OneDrive, Office 365, Pulse Software, PCS, Careskills Academy and others for the purposes of booking shifts, storing data online and meeting our obligations in terms of pay and pensions
• Drivers - for the purposes of arranging transport where necessary
Your personal data will never be sold. It will not be shared with third parties unrelated to our business and will only be used for the purposes for which it was collected.
It is necessary for us or relevant parties above to contact you for the purposes of arranging assignments, training days, workplace pensions, pay, etc.

Do you consent to contact from us and third parties by email, telephone and text message (Answering no will restrict our ability to book you for assignments)*

Yes

We may also process some sensitive personal data such as data consisting of racial or ethnic origin, religious or philosophical beliefs, data concerning health or data concerning a person's sexual orientation. This requires explicit consent please indicate your consent below We will keep your personal data for as long as it is reasonable to do so for the purpose it was collected and we believe it to be accurate. After that period it will be deleted. For further information, to opt out of communication, change your preferences, to exercise your 'right to be forgotten', to update the data we process or to request information about the data we process about you please contact us by phone 01752 858966, by email [email protected]

Comments

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Nurse Application Form

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Your Contact Information

Your Name*

First name Last name

Address*

Street Address Address Line 2 City County / State / Region ZIP / Postal Code Country

Tel no.*

Mobile*

Email*

Do you have a full UK driving license?*

Yes

Do you have access to a car?*

Yes

NI number*

NMC Pin*

Are you registered with any professional bodies?

HCPC (formerly HPC)

GMC

RCCP

NMC

GphC

Other

Registration Number*

Expiry/Renewal Date*

Nurse Type (e.g. RGN etc)*

Current Band*

Specialism*

Current DBS number*

Date issued*

DD slash MM slash YYYY

Date of birth*

DD slash MM slash YYYY

Emergency Contact

Your Name*

First name Last name

Relationship*

Tel no.*

Address*

Street Address Address Line 2 City County / State / Region ZIP / Postal Code Country

Work Preference

What hours would you prefer to work?*

Full Time

Part Time

Days

Nights

Any specific requirements?*

Education History

Place of study*

Courses taken/result*

Date of completion*

Place of study

Courses taken/result

Date of completion

Place of study

Courses taken/result

Date of completion

Work history

Company one*

Position*

Reason for leaving*

Dates of employment*

Company two

Position

Reason for leaving

Dates of employment

Company three

Position

Reason for leaving

Dates of employment

Company four

Position

Reason for leaving

Dates of employment

Workplace/Position

Right to Work in the UK

Nationality*

Do you hold a British/EU Passport*

Yes

If not, what Right to Work proof have you provided (e.g. VISA in passport, UK Biometric Residence Permit, etc.)*

Nursing Home (months/years)*