Screening Form

NOTE: Your information will be stored on your computer until you press "submit" so you can part fill in the form and come back to it without submitting. If you are on a shared or public computer and wish to abandon the form use the "Clear Form" button to delete your data.
Full Name*

First NameMiddle NameLast Name
Address*

Street Address

Street Address Line 2

CityCounty

Post CodeCountry
Contact Phone Number*
Email Address*
Clinical Grade*

DoctorECP / ENP / Paramedic PractitionerHCPC ParamedicNMC NurseIHCD / NHS TechnicianECA / ECSWEmergency responder / First ResponderOther
Professional Registration Number
Current Employer (If Applicable)
Current Working Pattern (I.e. part time / bank/full time etc)?
What sort of work pattern are you looking for or available for (ie full time, occasional, blocks of work, 2 days a week, 7 days a week, not sure?) *
Do you have any experience with filming or event work (this is not a requirement, so don't worry if you don't!)
Why would like like to work for LMS. Be specific to the role you are applying for.*
Why are you well suited to this role ? *
Please upload a passport photo

Upload a File

Cancelof
Do you have a Current DBS Check

NoYes, within last 12 monthsYes, Over 12 months agoYes and I subscribe to DBS update Service
Please upload your CV if you have one

Upload a File

Cancelof
Sometimes it can take some time for vancancies for specific skills to occur. Are you happy for us to keep your details on file and, potentially, contact you at any time in the future?
Permission to Retain your application on file*

I am mainly interesting in work now. If you don't think you have anything for me now, I'd rather you didnt retain my details. I understand that I can always re-submit them at any time.I am happy for you to keep my information on file and, if there is nothing for me right now ,potentially, contact me st some point in the future.
Declaration*

I understand that all stated qualifications and experience will be verified by LMS and confirm that the information provided above is accurate.I understand that, if successful, reference checks and DBS checks will be undertaken, and that any pending or relevant professional or criminal charges or investigations must be disclosed in full.
When you press submit we will upload your files. Please note this can take a couple of minutes.
Should be Empty:

NOTE: Your information will be stored on your computer until you press "submit" so you can part fill in the form and come back to it without submitting. If you are on a shared or public computer and wish to abandon the form use the "Clear Form" button to delete your data.