New Registration

Title *

Name *

First

Middle

Last

Date of Birth *

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Home Tel

Mobile Tel *

Email Address *

N.I. Number

Are you eligible to work in the UK? *

Yes
No

Do you hold a full UK driving license? *

Yes
No

If yes, Do you have any points or convictions, etc? *

Qualified Nurses only

Training School

From

To

Address

Address Line 1

Address Line 2

City

State / Province / Region

Country

Expiry date:

You are required to provide evidence of the above details at your interview by bringing with you:

Proof of eligibility to work in the UK (Passport/ Visa/ Birth Certificate, etc)
Driving License & Counterpart
Your last 3 months wage slips
National Insurance Card
P60/ P45
Bank Statement/ Utility Bill

Rehabilitation of Offenders Act

Have you ever been convicted of a criminal offence? *

Yes
No

Have you any prosecutions pending? *

Yes
No

If yes, please give details/ dates of offence(s) and sentence

(This information will be disclosed by the Disclosure and Barring Service (DBS) which will be required if successful. Please note a criminal record will not necessarily be a bar to employment)

Education

University/ College/ School *

Qualifications Gained *

Examinations taken (State Grades) *

Date From *

Date To *

Select to add more qualifications

Add more qualifications

University/ College/ School

Qualifications Gained *

Examinations taken *

Date From

Date To

University/ College/ School

Qualifications Gained *

Examinations taken *

Date From

Date To

Employment Record

Employer Name

Address

Address Line 1

Address Line 2

City

State / Province / Region

Country

Date From

Date To

Job Title/Job Function/ Responsibilities

Salary

Reason for Leaving

Select to add more more employment record

Add more employment record

Employer Name

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Date From

Date To

Job Title/Job Function/ Responsibilities

Salary

Reason for Leaving

Personal Statement

Please give the names and addresses of your two most recent employers (if applicable). If you are unable to do this, please clearly outline who your referees are. Can we contact your current employer before interview?

YES
NO

Reference 1

Name

Relationship

Organisation

Date Employed

From

Date Employed

To

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Phone

Email

Reference 2

Name

Relationship

Organisation

Date Employed

From

Date Employed

To

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Phone

Email

I confirm that the information provided in this application (and within my Curriculum Vitae if applicable) is both truthful and accurate. I have omitted no facts that could affect my employment. I understand that any false misleading statements could place any subsequent employment in jeopardy. I understand that any employment entered into is subject to documentary evidence of my right to work in the UK and satisfactory references. I expressly consent to personal data contained within this form being recorded for the purposes of assessing suitability for the post and may form the basis of any subsequent personnel file. *

YES

Andrewjons Limited undertakes that it will treat any personal information that you provide to us, or that we obtain from you, in accordance with the requirements of the Data Protection Act 1998. After initial assessment, Andrewjons Limited may keep your details on file pending suitable opportunities that may arise in the future. Please tick if you do not wish us to hold your details.

This section will be separated from your application form upon receipt and does not form part of the selection process. It will be retained by Human Resources purely for monitoring purposes.

What is your Ethnic group? *

Please state where not listed

Gender *

Male
Female

Disability (Do you consider yourself disabled?) *

Yes
No

Disability is defined as “physical or mental impairment, which has a substantial and long term adverse effect on a person’s ability to carry out normal day to day activities”.

If yes, please give details:

Please upload copies of Valid Passport, Biometric Residence Permit, Proof of address (Gas or Water Bill, Bank Statement), DBS, Biometric Card, Valid NMC, Academic Qualification, N.I. Letter, Work Report and up to date CV to support your application. *

Click or drag files to this area to upload. You can upload up to 11 files.

Asylum and Immigration Act 1996 It is now a requirement that before any offer of employment can be made, all candidates are to provide confirmation of their eligibility to work in the UK. Please bring one of the following original documents with you if invited to interview: a passport or an immigration and nationality directorate application registration card which evidence the right to work in the UK or a UK residence permit issued to an EEA national which confirms right of entry to or residence in the UK.

Qualified Nurses only

Rehabilitation of Offenders Act

Education

Employment Record

Personal Statement

Reference 1

Reference 2

Find us

quick links

our services