Join Us About You Qualifications & Experience Referees Declaration Submit Name Your Details Tell us about you. First name * Last name * Email Address * Home Address * Post Code * Telephone No * Mobile No * National Insurance No * Date of Birth * Nationality * Please select... Afghan Albanian Algerian American Andorran Angolan Antiguans Argentinean Armenian Australian Austrian Azerbaijani Bahamian Bahraini Bangladeshi Barbadian Barbudans Batswana Belarusian Belgian Belizean Beninese Bhutanese Bolivian Bosnian Brazilian British Bruneian Bulgarian Burkinabe Burmese Burundian Cambodian Cameroonian Canadian Cape Verdean Central African Chadian Chilean Chinese Colombian Comoran Congolese Costa Rican Croatian Cuban Cypriot Czech Danish Djibouti Dominican Dutch Dutchman Dutchwoman East Timorese Ecuadorean Egyptian Emirian Equatorial Guinean Eritrean Estonian Ethiopian Fijian Filipino Finnish French Gabonese Gambian Georgian German Ghanaian Greek Grenadian Guatemalan Guinea-Bissauan Guinean Guyanese Haitian Herzegovinian Honduran Hungarian I-Kiribati Icelander Indian Indonesian Iranian Iraqi Irish Israeli Italian Ivorian Jamaican Japanese Jordanian Kazakhstani Kenyan Kittian and Nevisian Kuwaiti Kyrgyz Laotian Latvian Lebanese Liberian Libyan Liechtensteiner Lithuanian Luxembourger Macedonian Malagasy Malawian Malaysian Maldivan Malian Maltese Marshallese Mauritanian Mauritian Mexican Micronesian Moldovan Monacan Mongolian Moroccan Mosotho Motswana Mozambican Namibian Nauruan Nepalese Netherlander New Zealander Ni-Vanuatu Nicaraguan Nigerian Nigerien North Korean Northern Irish Norwegian Omani Pakistani Palauan Panamanian Papua New Guinean Paraguayan Peruvian Polish Portuguese Qatari Romanian Russian Rwandan Saint Lucian Salvadoran Samoan San Marinese Sao Tomean Saudi Scottish Senegalese Serbian Seychellois Sierra Leonean Singaporean Slovakian Slovenian Solomon Islander Somali South African South Korean Spanish Sri Lankan Sudanese Surinamer Swazi Swedish Swiss Syrian Taiwanese Tajik Tanzanian Thai Togolese Tongan Trinidadian or Tobagonian Tunisian Turkish Tuvaluan Ugandan Ukrainian Uruguayan Uzbekistani Venezuelan Vietnamese Welsh Yemenite Zambian Zimbabwean Nurse PIN No SSSC Registration No Do you hold a valid UK Driving Licence? * YesNo Do you have access to a vehicle? * YesNo Do you have the right to work in the UK? * YesNo Next of Kin Relationship Address Post Code Home Tel No Mobile No Your Qualifications & Training Tell us about any relevant qualifications or training you have undertaken. Course Title coursetitle1 Course Description coursedescription1 Date coursedate1 coursetitle2 coursedescription2 coursedate2 coursetitle3 coursedescription3 coursedate3 coursetitle4 coursedescription4 coursedate4 coursetitle5 coursedescription5 coursedate5 Employment History List your employment history starting with the most recent first. Name & Address of EmployerPosition Held & DutiesDates To & FromReason for Leaving employerjob1 positionjob1 datesjob1 reasonjob1 employerjob2 positionjob2 datesjob2 reasonjob2 employerjob3 positionjob3 datesjob3 reasonjob3 employerjob4 positionjob4 datesjob4 reasonjob4 employerjob5 positionjob5 datesjob5 reasonjob5 Please enter below any additional comments regarding your work experience or qualifications/training. Referees Please give the name of two recent professional referees (not relatives), stating their position. - No character references - One Referee must be your current or most recent employer Referee 1 Company Name * Company Address * Post Code * Referee Name * Position Held * Telephone No * Email Address * Fax No Referee 2 Company Name * Company Address * Post Code * Referee Name * Position Held * Telephone No * Email Address * Fax No Referee 3 Company Name Company Address Post Code Referee Name Position Held Telephone No Email Address Fax No CompletionRehabilitation of Offenders Act 1974 By virtue of the Rehabilitaiton of Offenders Act 1974 (Exceptions) Order 1975, the provisions of Sections 4.2 and 4.3 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 such kind as to enable the holder to have access to persons in receipt of such services in the course of his/her normal duties. Your answers to the following question MUST include any 'spent' convictions. Have you ever been convicted of a criminal offence? * YesNo If YES, please provide details below, including dates Declaration I declare that I have answered the above questions honestly and fully, and I am not aware of any physical or mental disability which will, or may, affect my working capacity. I realise that any false or incomplete statement on my part will render me liable to disciplinary action or dismissal. * Agree Submit Thank you for your interest in working with Caledonia Healthcare. You can now submit your application for consideration (with the option to attach a CV or cover letter below), or you can use the 'previous' button to review your application.