Equal Opportunity
React HCP is committed to a policy of equal opportunities for all work seekers and shall
adhere to such a policy at all times and will review on an on-going basis on all aspects of recruitment to avoid
unlawful or undesirable discrimination. We will treat everyone equally irrespective of gender, 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 policy. React HCP shall not
discriminate unlawfully when deciding which candidate/temporary worker is submitted for a vacancy or
assignment, or in any terms of employment or terms of engagement for temporary workers. React HCP will ensure that each candidate is assessed only in accordance with the candidate’s merits,
qualification and ability to perform the relevant duties required by the particular vacancy.
Personal Details:
Surname
Forename (s)
Date of Birth
Address
Your Postcode
Phone Number
Email Address
NI Number
NMC Pin
If ‘yes’ please give details:
Criminal Convictions:
If ‘Yes’ please state convictions and dates
*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 taken into account where, in the reasonable opinion of React HCP, the offence is relevant to the post to which you are applying. 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.
Disclosure and Barring Service:
Relevant Qualification / Authorisation:
Qualification
Name of Institution
Date Obtained
Professional Membership:
Professional Body
Membership Details
Employment Details:
[Please detail your past work experience within the last 5 years, commencing with your most recent position]
Name of Employer:
Address:
Postcode:
Position held:
Period from:
To:
Reason for leaving:
Brief description of duties and responsibilities:
Courses
Date
References:
[Please provide two referees, one of which must be a previous or current employer]
Referee 1
Position:
Name:
Relationship:
Organisation:
Address:
Postcode:
Telephone:
E-mail:
Data Protection Statement:
The information that you provide on this form and on any CV given will be used by React HCP to provide you work finding servi ces . In p roviding this service to you, you consent to your
personal d ata being included on a computerised database and consent to us transferring your personal details to
our clients. We may 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.
Temporary Worker Declaration:
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.
If, during the course of a temporary assignment, the Client wishes to employ me direct, I acknowledge that React HCP will be e ntitl ed either to charg e t he clien t an introd uc tion/transfer fee, or to agr ee
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)
Signed by Temporary Worker
Date
DBS
Current DBS (this should be less than 6 months old). If you need a new DBS we can arrange this for you, however, this will be at a cost. Please bring this fee with you, when visiting our office, should you need to apply for a new DBS, Or if you have an online DBS put in your online reference number here:
Identity Acceptable photo identification documents include: • Passport • UK or EU National Identity Card • Full or provisional UK Photocard Driver's License (must include paper counterpart)
Photographs
We are able to accept a number of items of address-related evidence, including the following (please note that the document must bear your full name):
• A utility bill which is less than 3-months old
• A benefit statement which is less than 3-months old
• A mortgage statement which is less than 12-months old
• A UK Council Tax statement which is less than 12-months old
• HM Revenue & Customs tax notification which is less than 12-months old
• A credit card/bank/building society statement (we cannot accept statements printed on the internet) which is less than 3-months old
Right to Work
British citizens must provide either a passport, or a full UK birth or adoption certificate in combination with an official document issued by a previous employer or government agency bearing the individual's full name and permanent national insurance number (such as a P45, P60, payslip or letter from the HMRC - please note that a National Insurance (NI) number card is not in itself acceptable for this purpose).
For non-British citizens, the requirements are dependent on your nationality and current immigration status. For further guidance, please visit the UK Border Agency Web Site. The majority of non-British Citizens will be required to provide their Work Visa and details of any restrictions imposed.
SUBMIT APPLICATION
