Application for employment — North West Health & Care

1 Personal details

First name * Last name *

Email * Phone *

Date of birth National Insurance number *

Home address *

Postcode * Full UK driving licence & vehicle?

Role applied for * Preferred area

2 Right to work in the UK

Right to work status * Share code (if applicable)

We verify right to work for every applicant before employment begins, in line with Home Office guidance. Original documents will be checked at interview.

3 DBS (criminal record check)

Do you hold an Enhanced DBS? DBS certificate number

Registered with the DBS Update Service?

This role is exempt from the Rehabilitation of Offenders Act 1974. You must declare all convictions, cautions and reprimands that are not protected. A record does not automatically bar you from employment — each case is assessed individually.

Any convictions or cautions to declare? If yes, brief details

4 Employment history

Most recent employer first. A full history with explanations for any gaps will be confirmed before employment, as required by safer recruitment regulations.

Most recent employer

Employer Job title

From To

Reason for leaving

Previous employer

Employer Job title

From To

Reason for leaving

5 References

Two references required; one must be your most recent employer. References are always taken up before a first shift.

Referee 1 — name Relationship

Referee 1 — email Referee 1 — phone

Referee 2 — name Relationship

Referee 2 — email Referee 2 — phone

6 Health & emergency contact Do you have any health conditions or disabilities relevant to the role? (This helps us support you — it is not used to screen you out.) Any adjustments we should make for interview or work?

Emergency contact — name Relationship

Emergency contact — phone

7 Documents

Upload what you have now (PDF, JPG, PNG, DOC — max 10 MB each). Anything missing can be brought to interview.

Photo ID (passport / driving licence) Right to work evidence DBS certificate Proof of address Qualifications / training certificates CV

8 Declaration I confirm the information given is true and complete. I understand that false or misleading information may lead to withdrawal of any offer or dismissal. I consent to North West Health & Care processing this information, including special-category data, for recruitment purposes in line with UK GDPR and its privacy notice, and to it contacting my referees. *

Join a team that invests in you.

Most recent employer

Previous employer