Temptopia Healthcare – Candidate Hub

References

Please give the names of two referees – one of whom should be your current/most recent line manager (paid or voluntary work). School or college leavers may list a Teacher or Tutor as one referee. If you do not have a second work referee, the second referee may be a personal referee (but not a relative). We always take up references before confirming an offer of employment.

Next of Kin

Employment History (Fill in or Attach CV)

Current or Most Recent Employer (including Voluntary or Unpaid Work)

Previous Employment

Please give details of all jobs held/work history, including part-time and unpaid work, starting with the most recent first and clearly explain any gaps in your employment history.

Education, Qualifications and Training

What formal education, vocational/professional qualifications and training do you have? Please include everything you consider relevant. Continue on a separate sheet if necessary.

Healthcare Training

Please provide information about any training attended, plus certificate date.

Personal Health

Do you have or have you ever suffered from any of the following? (If Yes, please give details.)

Other Information

Working Time Preferences

Declaration

I am eligible for employment in the UK, and I am physically and mentally fit for work. To my knowledge, all the information I have provided on this application form is a true and complete record. I also acknowledge that the Contract of Employment Act 1972 applies to this application.

All information provided is subject to our confidentiality policy and the Data Protection Act. If you do wish to work more than 48 hours per week, it is necessary to sign the form below to show that you are available.

Rehabilitation of Offenders Act 1974

You are advised that you are not entitled to withhold information about convictions which are regarded as “spent under the Act”. This is due to the nature of the work involved which renders the post exempt from sec.4 (2) of the Act in accordance with the Rehabilitation of Offenders Act 1974 (exceptions) order 1975.

You are therefore required to give details of all convictions and cautions including spent one. All information is confidential and will be considered only in relation to this or similar position.

Disclaimer: Temptopia Healthcare Recruitment (THR) Limited will not assume responsibility for any false information supplied by the temp worker filling this form and therefore such responsibility will entirely be their responsibility and the consequences thereof. It’s a criminal offence to supply false information or documents with or without their knowledge.

Declarations

I can confirm that the information disclosed in this application form is relevant and correct and can be verified by references from previous employers and/or any professional bodies or character referees specified. I understand that the information I have disclosed may be divulged to companies or agents as deemed necessary by Temptopia Healthcare Recruitment Limited in relation to my application for work.

Whilst on assignment from Temptopia Healthcare Recruitment Limited, I will ensure my timesheet is returned to the branch by 2:00 p.m. on the Monday following the week of work. I will regard all available information as confidential and I will not divulge it to any third parties plus I will comply with the health & safety regulations of all the companies/agents I am assigned to. I also acknowledge that whilst working for Temptopia Healthcare Recruitment Limited, I will not provide a service, either on my own behalf or on behalf of any contractor to any individual or client of Temptopia Healthcare Recruitment Limited.

At the termination of this agreement between myself and Temptopia Healthcare Recruitment Limited, I will not provide a service either on my own behalf or on behalf of any other contractor to any individuals or clients of Temptopia Healthcare Recruitment Limited for whom I have provided a service during my engagement and for 6 months after the end of my contract with Temptopia Healthcare Recruitment Limited.