Join Us – DRITEWYSE

DRITEWYSE

+44 (0) 2080950660

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What We Do
About Us
Contact
Vacancies
Join Us

Registration form

Post applying for?

First Name

Middle Name

Last Name

Address

City

County

Postal Code

Phone

Email Address

National Insurance Details:

N.I. number

Do you have the right to work in The UK?

Yes No

Please provide details of your visa and any restrictions in the space provided below (if applicable)

Do you drive a car?

Yes No

Are you happy to drive to work?

Yes No

Next of Kin.( For emergency contact)

Full Name

Relationship

Next of Kin Tel

Next of Kin Address

Next of Kin Email

Next of Kin Mobile

Full Employment History

Upload CV

References

Please provide details of two people who can be contacted for a reference if you have not provided a full 5 year work history. The referee must be able to comment on your suitability and character for the post you have applied for (e.g. fellow work colleague or course tutor). Relatives and/or Partners should not act as referees. Referees will not be contacted without your consent.

Reference

Contact Name

Job Title

Address

Tel

Relationship to you

Number of years known

Reference 2

Contact Name

Job Title

Address

Tel

Relationship to you

Number of years known

EQUAL OPPORTUNITY MONITORING FORM

The information on this form will be used in total confidence and accordance with current data protection legislation. It will help to ensure that the company property monitors and comply with its policies relating to equality of opportunity. Information will be used for monitoring only. Our commitment aims to allow our staff to develop their skills and realize their maximum potential as individuals without any wish on the part of the company to limit their opportunity.

ETHNICITY

White Mixed Asian Black Chinese Other

OTHER ETHNICITY (Please state)

GENDER

Male Female Other

OTHER GENDER (Please state)

PLEASE INDICATE YOUR AGE RANGE BY TICKING ONE OF THE BOXES BELOW

18-21 22-25 26-30 31-35 36-40 41-45 46-50 51-60 60-65

DO YOU CONSIDER YOURSELF TO HAVE A DISABILITY OF SOME KIND?

Yes No

If yes, give details

Disclosure of criminal record information

DUE TO THE NATURE OF THE WORK FOR WHICH YOU ARE APPLYING, THIS POST IS EXEMPT FROM THE PROVISIONS OF SECTION 4(2) OF THE REHABILITATION OF OFFENDERS ACT 1974, BY VIRTUE OF THE REHABILITATION OF OFFENDERS 1974 (EXCEPTIONS) ORDER 1975. THIS MEANS THAT CONVICTIONS THAT ARE ‘SPENT’ UNDER THE TERMS OF THE REHABILITATION OF OFFENDERS ACT 1974 MUST BE DISCLOSED AND WILL BE TAKEN INTO ACCOUNT IN DECIDING WHETHER TO MAKE AN APPOINTMENT. APPLICANTS ARE THEREFORE NOT ENTITLED TO WITHHOLD INFORMATION ABOUT CONVICTIONS, WHICH FOR OTHER PURPOSES ARE SPENT UNDER THE PROVISIONS OF THE ACT AND IN THE EVENT OF EMPLOYMENT ANY FAILURE TO DISCLOSE SUCH CONVICTIONS COULD RESULT IN DISMISSAL OR DISCIPLINARY ACTION BY THE EMPLOYER. ALL SUCCESSFUL CANDIDATES WILL BE REQUIRED TO OBTAIN AN ENHANCED DISCLOSURE REPORT FROM THE DISCLOSURE AND BARRING SERVICE. .ANY INFORMATION WILL BE COMPLETELY CONFIDENTIAL AND WILL BE CONSIDERED ONLY IN RELATION TO THIS APPLICATION.

HAVE YOU EVER BEEN CONVICTED OF A CRIMINAL OFFENCE, OR BEEN SUBJECT TO ANY CONFIDENTIAL DISCHARGE, BIND-OVERS OR CAUTIONS?

Yes No

If yes, give details

HAVE YOU EVER BEEN CONVICTED OF ANY CRIMINAL OFFENCE?

Yes No

If yes to question above, please give details.

HAVE YOU EVER RECEIVED ANY OFFICIAL CAUTIONS, REPRIMANDS OR WARNINGS?

Yes No

If yes to question above, please give details.

ARE YOU CURRENTLY THE SUBJECT OF ANY CRIMINAL PROCEEDINGS OR ANY POLICE INVESTIGATION?

Yes No

If yes to the question above, please give details.

I declare that I do not possess, nor have I ever possessed a criminal conviction, nor have I been subject to any conditional discharges, bind-overs or cautions

ANY INFORMATION CONTAINED IN THIS FORM WILL BE TREATED IN CONFIDENCE. FAILURE TO DISCLOSE ANY RELEVANT INFORMATION OR PROVIDING FALSE OR INACCURATE INFORMATION MAY BE REGARDED AS A BREACH OF ANY SUBSEQUENT CONTRACT OF EMPLOYMENT, RESULTING IN DISCIPLINARY ACTION AND / OR DISMISSAL. *

HEALTH CHECK QUESTIONNAIRE

GP Contact Details

PLEASE ANSWER THE FOLLOWING QUESTIONS BY GIVING RELEVANT DETAILS

Have you ever suffered from any of the following:

DEPRESSION, ANXIETY STATE, NERVOUS ILLNESS OR BREAKDOWN

Yes No

If Yes

EPILEPSY OR DISEASE OF THE NERVOUS SYSTEM

Yes No

If Yes

AILMENT OF LUNGS OR CHEST

Yes No

If Yes

SPINAL PROBLEM (BACKACHE)

Yes No

If Yes

ARTHRITIS, RHEUMATISM OR GOUT ETC

Yes No

If Yes

ANY HEART OR CIRCULATORY, INCLUDING BLOOD PROBLEMS

Yes No

If Yes

ILLNESS OF THE KIDNEYS, BLADDER, LIVER OR GLANDS

Yes No

If Yes

DIABETES

Yes No

If Yes

SKIN DISORDER

Yes No

If Yes

Are you presently taking medication or undergoing treatment. If so give details.

ARE YOU A REGISTERED DISABLED PERSON?

Yes No

How many working days have you been absent from working during the last 12 months (apart from holidays)

Additional Details: (if necessary)

Notes

Data Protection:

THE HEALTHCARE RECRUITMENT PRIVACY STATEMENT IS AVAILABLE ON OUR WEBSITE (WWW.DWCSLTD.CO.UK) OR A COPY CAN BE REQUESTED FROM THE HUMAN RESOURCES DEPARTMENT. PLEASE SIGN BELOW TO CONFIRM YOU HAVE ACCESSED THE DRITEWISE CARE AND SUPPORT LIMITED HEALTHCARE RECRUITMENT PRIVACY STATEMENT AND YOU HAVE READ, UNDERSTOOD AND AGREE TO ALL THE TERMS STATED.

Date

Name

DECLARATION

I DECLARE THAT THE INFORMATION GIVEN IN THIS APPLICATION IS TO THE BEST OF MY KNOWLEDGE, COMPLETE AND CORRECT. I ACCEPT THAT SHOULD ANY STATEMENT MADE BY ME IN CONNECTION WITH THIS APPLICATION BE FOUND TO BE FALSE, INCOMPLETE OR MISLEADING THEN THE APPLICATION SHALL BE VOID AND CONSEQUENTLY, DRITEWISE CARE AND SUPPORT LIMITED MAY TERMINATE ANY CONTRACT ARISING AT ANY TIME. BECAUSE OF THE SENSITIVE NATURE OF THE DUTIES THE POSTHOLDER WILL BE EXPECTED TO UNDERTAKE, I UNDERSTAND THAT THE DECLARATION WILL INCLUDE DETAILS OF ANY CRIMINAL CONVICTIONS, CAUTIONS, REPRIMANDS AND FINAL WARNINGS THAT ARE NOT ‘PROTECTED’ AS DEFINED BY THE REHABILITATION OF OFFENDERS ACT 1974 (EXCEPTIONS) ORDER 1975 (2013) AND ANY OTHER INFORMATION THAT MAY HAVE A BEARING ON MY SUITABILITY FOR THE POST. I ALSO UNDERSTAND THAT THE RELEVANT LEVEL OF DBS CHECK WILL BE SOUGHT IN THE EVENT OF A SUCCESSFUL APPLICATION

Name

Date

Tick the box to accept out T&C and Privacy policy.

Address

71-75 Shelton Street, Covent Garden, London, WC2H 9JQ
02080950660
+44 (0) 7900385239 (Out of Hours)
Info@dwcsltd.co.uk

Registration form

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