Employment Application - GDB Healthcare Services Company Limited

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    Step 1 of 5

    Personal Details









    Step 2 of 5

    Personal Details





    Employment History (please complete in full and use a separate sheet if necessary) Last/Current Employment Name of Employer: Address: Dates of Employment: Job Title: Duties: Rate of Pay: Reason for Leaving: Notice Period: Previous Employment #2 Name of Employer: Address: Dates of Employment: Job Title: Duties: Rate of Pay: Reason for Leaving: Previous Employment #3 Name of Employer: Address: Dates of Employment: Job Title: Duties: Rate of Pay: Reason for Leaving:

    Step 3 of 5



    Current Membership of Professional bodies (i.e. CIPD, NMC) Please note any professional bodies you are a member or registered with: Other Employment Please note any other employment that you would continue with if you were to be successful in obtaining the position:

    Step 4 of 5



    References (please note here two persons from whom we may obtain both character and work references) Reference #1 Title: Forename(s): Surname: Address: Post Code: Contact No. May we approach the above prior to interview? Yes No Reference #2 Title: Forename(s): Surname: Address: Post Code: Contact No. May we approach the above prior to interview? Yes No

    Step 5 – Final Step



    Criminal Record Please note any criminal convictions except those ‘spent’ under the Rehabilitation of Offenders Act 1974. If none please state. In certain circumstances employment is dependent upon obtaining a satisfactory Disclosure & Barring Certificate from the Disclosure & Barring Service/Disclosure Scotland. Data Protection 1. We are aware of our obligations under data protection legislation, including the obligation to collect only the data that is required for our specific purpose. The information collected in this application form is specific to our recruitment exercise and necessary for the performance of the role that you have applied for. If you are recruited for the role you have applied for, or any other role you are offered by us, the information provided will then be used for the purposes of your employment with us, together with further information collected upon recruitment for those purposes. 2. We will treat all personal information about you with utmost integrity and confidentiality. Our data protection policy sets out our approach to ensuring that your data is processed in line with the data protection principles within current data protection legislation. 3. Our privacy notice for job applicants gives you information on, amongst other things, the data we will hold about you during the recruitment exercise and what we use it for. Delete as applicable – A copy of the privacy notice is attached to this application form / You can view the privacy notice at (insert web address). Declaration (please read this carefully before signing this application) 1. I confirm that the above information is complete and correct and that any untrue or misleading information will give my employer the right to terminate any employment contract offered. 2. I understand that the company will inform me of their intention to contact my doctor with a view to obtaining a medical report, should they require further medication information, and that my agreement will be sought before my doctor is contacted. I also understand that the organisation reserves the right to require me to undergo a medical examination. In addition, I agree that this information will be retained in my personnel file during employment and for up to six years thereafter and understand that information will be processed in accordance with data protection legislation. 3. I agree that should I be successful in this application, I will, if required, apply to the Disclosure & Barring Service/Disclosure Scotland for a Disclosure & Barring Certificate. I understand that should I fail to do so, or should the disclosure not be to the satisfaction of the company any offer of employment may be withdrawn or my employment terminated. Signed: Date: Please prove you are human by selecting the star.