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First Name *

Last Name *

Street Address *

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Country

Email *

Position Applied For

Position *

How did you hear about the position *

Driving

DO YOU HOLD A FULL UK OR EUROPEAN ECONOMIC AREA (EEA) DRIVING LICENCE? *

YesNo

IF YES, HAS YOUR DRIVING LICENCE BEEN ENDORSED? *

YesNo

DO YOU HAVE A VEHICLE YOU CAN USE FOR BUSINESS PURPOSES IF REQUIRED? *

YesNo

If yes, please explain *

Full Employment History

Please list below your complete and full employment history, explaining all employment gaps, starting with your most recent employer, working backwards to when you left full-time education (continue on a separate sheet if necessary). Please also attach a full CV (if possible).

Upload Resume/CV

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Eligibility to work in the UK:

DO YOU HAVE THE RIGHT TO WORK IN THE UK?

YesNo

Other Employment

To allow us to monitor your working hours and comply with current legislation, please complete the following section:

IF YOU ARE SUCCESSFULLY APPOINTED TO THE POST APPLIED FOR, DO YOU INTEND TO CONTINUE WITH OTHER EMPLOYMENT?

YesNo

Disclosure of criminal record information

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 Rehabilitation of Offenders Act 1974, by virtue of the Rehabilitation of Offenders 1974 (Exceptions) Order 1975. This means that convictions that are ‘spent’ under the terms of the Rehabilitation of Offenders Act 1974 must be disclosed and will be taken into account in deciding whether to make an appointment. Any information will be completely confidential and will be considered only in relation to this application. Please read the above carefully and then answer the following questions:

HAVE YOU EVER BEEN CONVICTED OF A CRIMINAL OFFENCE?

YesNo

HAVE YOU EVER RECEIVED ANY OFFICIAL CAUTIONS, REPRIMANDS OR WARNINGS?

YesNo

TO YOUR KNOWLEDGE, ARE YOU CURRENTLY THE SUBJECT OF ANY CRIMINAL PROCEEDINGS OR ANY POLICE INVESTIGATION?

YesNo

Data Protection:

The Zillah Healthcare Privacy Statement is available on our website (www.zillahhealthcare.co.uk) or a copy can be requested from the Human Resources Department. Please confirm you have accessed the Zillah Healthcare Privacy Statement and you have read, understood and agree to all the terms stated.

I confirm that i have understood the private policy

Date

Declaration:

I declare that the information given in this application is to the best of my knowledge, complete and correct. I accept that should any statement made by me in connection with this application be found to be false, incomplete or misleading then the application shall be void and consequently, Zillah Healthcare may terminate any contract arising at any time.

I confirm that i have understood the private policy

Date

Position Applied For

Are you applying for *

Driving

DO YOU HOLD A FULL UK OR EUROPEAN ECONOMIC AREA (EEA) DRIVING LICENCE? *

IF YES, HAS YOUR DRIVING LICENCE BEEN ENDORSED? *

DO YOU HAVE A VEHICLE YOU CAN USE FOR BUSINESS PURPOSES IF REQUIRED? *

Full Employment History

Please list below your complete and full employment history, explaining all employment gaps, starting with your most recent employer, working backwards to when you left full-time education (continue on a separate sheet if necessary). Please also attach a full CV (if possible).

Eligibility to work in the UK:

DO YOU HAVE THE RIGHT TO WORK IN THE UK?

Other Employment

To allow us to monitor your working hours and comply with current legislation, please complete the following section:

IF YOU ARE SUCCESSFULLY APPOINTED TO THE POST APPLIED FOR, DO YOU INTEND TO CONTINUE WITH OTHER EMPLOYMENT?

Disclosure of criminal record information

HAVE YOU EVER BEEN CONVICTED OF A CRIMINAL OFFENCE?

HAVE YOU EVER RECEIVED ANY OFFICIAL CAUTIONS, REPRIMANDS OR WARNINGS?

TO YOUR KNOWLEDGE, ARE YOU CURRENTLY THE SUBJECT OF ANY CRIMINAL PROCEEDINGS OR ANY POLICE INVESTIGATION?

Data Protection:

The Zillah Healthcare Privacy Statement is available on our website (www.zillahhealthcare.co.uk) or a copy can be requested from the Human Resources Department. Please confirm you have accessed the Zillah Healthcare Privacy Statement and you have read, understood and agree to all the terms stated.

Declaration:

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