Alexima Care Services is committed to a policy of equal opportunities for all prospective employees and will continuously review on an on-going basis, all aspects of recruitment processes to eliminate unlawful or undesirable discrimination. Everyone is treated equally irrespective of sex, sexual orientation, gender reassignment, marital or civil partnership status, age, disability, colour, race, nationality, ethnic or national origin, religion or belief, political beliefs or membership or non-membership of a Trade Union and we place an obligation upon all staff to respect and act in accordance with the said policy.

Alexima Care Services will ensure prospective employees are assessed the merit, qualification and their ability to perform relevant duties required by a particular vacancy.

List all professional qualifications held and training courses undertaken. Professional qualifications and training will be verified. Continue on a separate sheet if necessary. Please provide photocopies of all certificates. (For convenience, and where appropriate, please state “please see CV”.)

In line with Government legislation under the terms of “Working Time Regulations” we recommend that your working hours should not exceed 48 hours per week (average over a 17-week period). Should you wish to waive this right, please confirm below:

Asylum and immigration act 1998

Section 8 of the Act makes it a criminal offence for employers to engage an individual who does not have permission to work within the U.K. Any offer of employment may be subject to you providing evidence of your right to work within the U.K. e.g. National Insurance number, passport or travel document endorsed to permit working in the U.K.

Certain types of employment and professions are exempt from the Rehabilitation of Offenders Act 1974 and in those cases particularly where the employment is sought in relation to positions involving working with children or vulnerable adults, details for all criminal convictions must be given. The information given will be treated in the strictest of confidence and only considered where the offence is deemed to have a bearing on the post to which you are applying for. Failure to declare a conviction may require us to exclude you from our register or terminate an assignment if the offence is not declared but later comes to light. A criminal record will not necessarily be a bar to obtaining a position. Disclosure information will not be used unfairly.

Convictions will not necessarily be a bar to obtaining a post. However, because of the nature of the work for which you are applying, this post is exempt from the provisions of Section 42 of the Rehabilitation of Offenders Act 1974. Applicants must declare information about convictions, cautions, reprimands and final warnings, for which other purposes are “spent” under the provisions of the Act.

Please confirm you have had the following immunisations and provide recent serology reports:

Professional Referees

Please supply two recent professional referees from your current/last substantive post. If this is not possible, please contact us to discuss suitable alternatives.

Reference 1

Reference 2

If you require to be paid through a UK Limited or Composite company, then the following details are required. NB. Certificates of registration will be required.

Please note, if you wish to be paid via a LTD Company, Alexima Care Services can only accept LTD Company Bank Account information.

The following questions on health and disability are asked in order to establish your needs in terms of reasonable adjustments required to access our recruitment service and to assess your needs in relation to the job or position sought.

Any patient information obtained by you during the course of your duties is confidential and should not be disclosed to any third party if it is not legitimately in connection with their treatment or any other official investigation. Please take care with patient records when on assignment to ensure that they are not in undue danger of being accessed by unauthorised individuals. Patients’/clients’ information should only normally be shared with their consent – you should make sure patients/clients understand that their information may be shared with various members of the team providing care. It is a patient’s/client’s decision what information should be shared with their family or others. Where a patient/client is considered incapable of giving consent, please consult relevant colleagues. Where a patient/client has withheld consent, disclosures of information may only be made if:

• They can be justified in the public interest (normally where the disclosure is essential to protect the patient/client or someone else from risk of significant harm).
• They are required by law or court order
• You should act in accordance with local and national policies if there is an issue of child protection.

The information that you provide on this form and on any CV given will be used by Alexima Care Services to provide you work finding services. In providing this service to you, you consent to your personal data being included on a computerised database and consent to us transferring your personal details to our clients. We ma y check the information collected, with third parties or with other information held by us. We may also use or pass to certain third parties’ information to prevent or detect crime, to protect public funds, or in other way permitted or required by law.

I hereby confirm that the information given is true and correct. I consent to my personal data and CV being forwarded to clients. I consent to references being passed onto potential employers. I consent to my information being made available for the purpose of audit to third parties.

If, during the course of a temporary assignment, the Client wishes to employ me direct, I acknowledge that Alexima Care Services will be entitled either to charge the client an introduction/transfer fee, or to agree an extension of the hiring period with the Client (after which I may be employed by the Client without further charge being applicable to the Client).

I will inform Alexima Care Services immediately of any circumstances that may affect my work, such as changes to health, subsequent pending prosecutions or convictions, which may arise whilst I am registered for permanent or temporary work. I understand that Alexima Care service has the right to request a Criminal Records Bureau Disclosure and/or credit check where they consider it necessary and that any details from this, or any other police checks provided, may be forwarded to a potential employer.

I give permission for Alexima Care Services to contact a third party for information needed for my file (I.e. Qualification Verification, Training Certificates, Immunisation reports etc.)