We are delighted you want to be part of our team!

Please fill in the application form below to apply now:

1. Personal Details

• Name (Required):
  Dr/Miss/Mr/Mrs/Ms/Prof./Rev. Title First Last

  • Maiden Name (if applicable)
  • Home Phone Number
  • Mobile Number (Required)
  • Email (Required)
  • Address (Required):
    Street Address
    Address Line 2
    City/Town
    County
    Postcode
  • Right to Work (Required):
    I confirm that I have a right to work in the UK.

• Your National Insurance Number: (Required)

• Are you registered with NMC or NISCC? (Required)
  Yes
  No

  • What is your NMC/NISCC number? (Required)
  • What is your NMC/NISCC certificate expiry date? (Required)
    DD slash MM slash YYYY

• Do you have your own form of transport? (Required)
  Yes
  No

  • Driving Licence No.

• Have you worked for an agency within the last 3 months? (Required)
  Yes
  No

  • Which agency or agencies did you work for? (Required)

2. Additional Details

3. Next of Kin

• Name (Required)
  • Maiden Name (if applicable)
  • Address (Required)
  • Contact No. (Required)
  • Relationship to you: (Required)
  • Consent (Required)
    Please tick to confirm that the person named has given their consent to be contacted as your next of kin.

4. Convictions/Investigations

INVESTIGATIONS/REPORTS

• Have you ever been the subject of an Adult or Child Abuse investigation or been previously referred to the Independent Safeguarding Authority/DBS as a result of misconduct involving a child or a vulnerable adult? (Required)
  Yes
  No
  • If yes, provide full details below: (Required)
• Have you ever been reported to NMC/NISCC? (Required)
  Yes
  No
  • If yes, provide full details below: (Required)

CONVICTIONS/OFFENCES

• Due to the services provided the majority of posts within the Company are governed by the Protection of Children & Vulnerable Adults (NI) Order 2003 and the Rehabilitation of Offenders (Exceptions) Order NI 1979. Disclosure of offences will not automatically debar you from applying for the post.
• Do you have any convictions that are not “protected” as defined by the Rehabilitation of Offenders (Northern Ireland) Order 1978, as amended in 2014? (Required)
  Yes
  No
  • If yes, provide full details below: (Required)

All disclosures will be reviewed for compatibility with the post.

5. Employment

Our governing body, RQIA requires all applicants to provide a full employment history. Please detail your employment history from when you left school to present.

Please also include periods of time when you were not in paid employment, caring for relatives, time spent in education/training, travelling or volunteering at home or abroad.

Current/Most Recent Employer

• No Employment History
  Please check this box and move onto the next part if you have never had a job before.

Current/Most Recent Employer

• Job Title
• Employer (name & address)
• Start Date (dd/mm/yy)
• End Date (dd/mm/yy)
• Hourly Rate/Salary
• Reason for leaving

Previous Employers (please list all since leaving school starting with most recent)

• Job Title
• Employer (name & address)
• Start Date (dd/mm/yy)
• End Date (dd/mm/yy)
• Hourly Rate/Salary
• Reason for leaving

Please click on the + button to add more employers.

• Do you need to add anymore employers to your employment history? (Required)
  Yes
  No

Please complete a paper application form with your remaining previous employers.

Break in Employment

• Do you need to provide details of any periods you were not working since leaving school? (Required)
  Yes
  No

• Date from (Required):
  DD slash MM slash YYYY

• Date to (Required):
  DD slash MM slash YYYY

• Please provide details for this break in employment: (Required)

• Do you need to provide any further details of period you were not working? (Required)
  Yes
  No

• Please provide further details of dates and reasons for further periods of not working: (Required)

6. Criteria

Please provide any other information which may be relevant to this application, detailing how you meet each of the criteria: (Required)
0 of 500 max characters

7. References

Please complete the details of two reference which must include your present/most recent employer.

Relatives cannot be named as referees.
Character references can be sought from a GP, religious official or friend who is not a relative.

We will only seek references after an offer of employment is accepted. We may seek references from your previous employers if one from your current/most recent employer is unobtainable. Please note we are required to obtain a reference from all previous employments within Health & Social Care. Please complete reference details in full.

Please tick the box to allow us to complete and receive references for you:

Reference 1 (Most Recent Employer)

• Name of Reference 1 (Most Recent Employer) (Required)
• Company Name
• Address (inc. postcode) (Required)
• Telephone Number (Required)
• Email address (Required)
• Capacity Known (Required)
• How does this person know you?
• Employed From
  DD slash MM slash YYYY
• Employed To
  DD slash MM slash YYYY

Reference 2 (Character/Employer)

• Is this a character or employer reference? (Required)
  Character
  Employer
• Name of Reference 2 (Employer/Character) (Required)
• Company Name
• Address (inc. postcode) (Required)
• **Telephone Number (