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0208 058 1445
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0208 058 1445
  • Home
  • About us
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  • Staffing
  • Work for us
  • Jobs
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1Your Personal Details
2Employment & Education
3Skills & Training
4Declaration & Terms
  • Vital Personnel
  • Personal Details 1

  • DD slash MM slash YYYY
  • Address

  • Personal Details 2

  • Accepted file types: jpg, gif, png, jpeg, pdf, Max. file size: 2 GB.
    This photo will be used for both your ID badge and your profile. Please make sure your face is clear in the photo.
  • Employment Eligibility

  • DD slash MM slash YYYY
    If it has no expiry please put a day 10 years from today.
  • Drop files here or
    Accepted file types: jpg, gif, png, jpeg, pdf, Max. file size: 128 MB, Max. files: 10.
      If you wish you can upload a clear photo of the document/s from your phone and bring along your original document/s if and when invited to the interview.
    • Drop files here or
      Accepted file types: jpg, gif, png, jpeg, pdf, Max. file size: 128 MB, Max. files: 10.
        If you wish you can upload a clear photo of the document/s from your phone and bring along your original document/s if and when invited to the interview.
      • Driving Details

      • Please note: you have to provide copies of all IELTS certificates held by you.

      • Next of kin details

      • Your Work Preference

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      • EDUCATION & EMPLOYMENT HISTORY

      • Please ensure you complete this section even if you have a CV. The NHS states that “Employment history should be recorded on an Application Form which is signed” Please ensure that you leave no gaps unaccounted for and it covers full work history including your education. Please use extra paper if required.


        Full work history including your education
        Dates to and from are shown in a mm/yy format
        Dates are continual with NO gaps
        Where there have been gaps in work history please state the reason for the gaps
        Lists all relevant training undertaken

      • EmployerPositionDutiesDate From - ToSalary on leaving 
      • Education

        Please supply documentary evidence.
      • InstitutionCourseYearGrade 
      • Accepted file types: jpg, gif, png, pdf, jpeg, docx, Max. file size: 128 MB.
      • REFERENCES

      • Please supply us with two professional referees. One must be from your present or most recent employer and must be a senior grade to yourself and you must have worked for that person for a period of not less than three months duration. By entering the referees' details, you give us permission to contact them.

      • Reference 1

      • Reference 2

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      • SKILLS, EXPERIENCE & TRAINING

      • Mandatory Training

        Please enclose copies of your training certificates
      • Please add dates of training.
      • Other Training/Courses & Qualifications

      • Please add dates of training.
      • APRAISALS

        In order to work in the NHS you will need to be appraised annually by a Senior Practitioner of the same discipline, this person will become your “appraiser” Please give details below of the Senior Practitioner who you have made arrangements with to act as your appraiser.
      • DD slash MM slash YYYY
      • YOUR DBS STATUS & UNIFORM

      • DBS Status

        Please send a copy of your most recent DBS Disclosure (formally known as CRB)
        Current DBS Disclosure (formally known as CRB)
      • DD slash MM slash YYYY
      • All applicants who cannot provide a registered DBS or full immunisation record will be required to complete at their own cost. The company will cover the cost of any Mandatory Training updates however cancellations outside of 48 hours and late attendances will be charged to the candidate.

      • Uniform

        Candidates will be required to purchase uniform if required at the cost of £20 this will be deducted from your timesheet once you have started working through us. Please fill in the box below stating your uniform size and quantity.
      • While we fully understand the value and importance of inclusivity in the workplace, our current uniform suppliers are only able to offer sizes in male and female. Please choose whichever size from either range that you feel would fit you best.

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      • DECLARATIONS

      • Health Declaration

      • GP Details

      • The above information will be held in strict confidence. If you aware of any health issue that you feel may affect your ability to undertake responsibilities of the post it is your responsibility to inform the Care Manager immediately. Again any details discussed in the meeting will be held in strict confidence.
      • MEDICAL HISTORY

        All staff groups complete this section
      • (If you have answered yes to any questions above please provide additional information below)
      • Tuberculosis

        Clinical diagnosis and management of tuberculosis, and measures for its prevention and control (NICE 2006)
      • DD slash MM slash YYYY
      • Chicken Pox or Shingles

      • DD slash MM slash YYYY
        Please state date
      • Immunisation History

      • Varicella

        You must provide a written statement to confirm that you have had chicken pox or shingles however we strongly advise that you provide serology test result showing varicella immunity

        Tuberculosis

        We require an occupational health/GP certificate of a positive scar or a record of a positive skin test result (Do not Self Declare)

        Rubella, Measles & Mumps

        Certificate of “two” MMR vaccinations or proof of a positive antibody for Rubella Measles & Mumps

        Hepatitis B

        You must provide a copy of the most recent pathology report showing titre levels of 100lu/l or above

      • Hepatitis B Surface Antigen

        Evidence of a negative Surface Antigen Test Report must be an identified validated sample. (IVS)

        Hepatitis C

        Evidence of a negative antibody test Report must be an identified validated sample. (IVS)

        HIV

        Evidence of a negative antibody test Report must be an identified validated s ample. (IVS)

      • Exposure Prone Procedures

      • Declaration

      • Disclosure Barring Service (DBS)

        The Disclosure and Barring Service (DBS – formerly Criminal Records Bureau CRB) is the executive agency of the Home Office responsible for conducting checks on criminal records. We are registered body for receipt of DBS disclosure information. NHS Trust and Private Sector hospitals and nursing homes insist on agencies making information recruitment decisions which require DBS checks to be made on all staff. It is a condition of proceeding with your application that you apply for a DBS disclosure check. The disclosure will be compared with the information given below and any inconsistencies could invalidate your application or lead to the cancellation of your registration with us.
      • Rehabilitation of Offenders Act 1974 and Criminal Records

        By the virtue of the Rehabilitation of Offenders Act 1974 (Exemptions) (Amendments) Order 1986 the provision of section 4.2 of the Rehabilitation of Offenders Act 1974 do not apply to any employment which is concerned with the provision of health services and which is of such a kind to enable the holder to have access to persons in receipt of such services in the course of his/her normal duties. You should there force list all offences below even if you believe them to be ‘spent’ or ‘out of date’ for some other reason.
      • Right To Work

        It is a legal requirement that before any offer of work can be made all candidates provide the company with confirmation of their eligibility to work in the UK by providing one of the original documents detailed below.
      • Work Time Directives

        It is a legal requirement that before any offer of work can be made all candidates provide the company with confirmation of their eligibility to work in the UK by providing one of the original documents detailed below.
      • Registration form Declaration

        I declare that all information given in this registration form is to the best of my knowledge complete and accurate in all respects and that I am eligible to work in the UK. I understand that any false or misleading information may result in my removal from the register of members.
      • DD slash MM slash YYYY
      • Reset signature Signature locked. Reset to sign again
      • This field is for validation purposes and should be left unchanged.
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      Contact Details

      T: 0208 058 1445
      E: info@vitalpersonnel.co.uk
      E: recruitment@vitalpersonnel.co.uk

      Address

      137-139 High Street,
      Beckenham, Kent,
      BR3 1AG

      Opening Hours

      Mon-Fri: 9:00am – 5:00pm
      Saturday: Closed
      Sunday: Closed

      Copyright 2022 © Vital Personnel Limited, Registered in England & Wales, Company Reg: 14273943
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