FM Logo RGBRe: Application for the position of Qualified Relief Nurse
Please find enclosed an application pack for the above position.
Once you have completed the application form please return to:
Relief Staff Co-ordinator
Essex SS13 3DU
Unfortunately we are unable to respond to all applicants. If you have not heard from us within 4 weeks of the submission of your application form then I am afraid this means you have not been successful on this occasion.
Relief Staff Co-ordinator
Direct Line: 01268 499219 Fax: 01268 498587
FM Logo RGBAPP. No.
APPLICATION FOR EMPLOYMENT
This form will need to be photocopied. Please write clearly in BLACK INK. Please complete this form in full and return to:
Maria Tickner, Family Mosaic, Pembroke House, Northlands Pavement, Pitsea, Essex SS13 3DU Maria.email@example.com
CVs will not be acceptedwww.familymosaic.co.uk
POST APPLIED FOR: Qualified Nurse (Relief) | REF: |
1. PERSONAL DETAILS
Surname | First Names |
Address Postcode National Insurance No. | Telephone: Mobile Evening Day Email |
2. SECONDARY AND FURTHER EDUCATION
All candidates who are shortlisted for interview may be required to provide certificates or qualifications as detailed below | Name & Address of Schools attended | From | To | Qualifications | Grade/ Result | Date | Name & Address of College/University | | | | | | Membership of Professional Bodies Membership No: Date Admitted: |
3. PRESENT AND PAST EMPLOYMENT DETAILS (Current or most recent first. Please include any period of unemployment or explain gaps in your work history.) Employer/Employers’ Address | Position held Give a brief description of your duties | Salary Grade and reason for leaving | Dates |
From | To |
4. FURTHER INFORMATION
Use this space to give further details in support of your application. In particular, say why you want the job and what relevant experience you have. You may wish to include details of any voluntary work, outside interests or activities, special skills or qualities you have. Continue on a separate sheet if necessary. |
How much notice do you need to give your current employer? Please give any dates when you will not be available for an interview |
6. HEALTH AND GENERAL ATTENDANCE
Please give details of how many days’ absence you have had in the last two years as a result of ill health Please give details of any illness which caused you to be absent from work for 10 or more continuous days or more than 28 days in one year during the last two years. These details will be confirmed with your present employer, educational establishment, etc, or may be confirmed via our occupational health advisor. Family Mosaic reserves the right to request a full pre-employment medical on applicants. |
7. ABOUT YOURSELF
Have you any criminal convictions? Yes No If the answer to the above is ‘Yes’, please specify below or on a separate sheet. (Appointment to certain posts, as stated in advertisements and job packs, is subject to a criminal record check. By signing the Declaration you accept that the organisation will seek information from the Criminal Records Bureau and any associated special lists, where we have stated it is necessary to do so.) Are you or your partner related to any employees or members of Family Mosaic? If so, please give details Are you or your partner related to anyone who is, or has been in the last 12 months, a member of Family Mosaic’s staff or Committees? If so, please give details. | Are you a tenant of the Association? Y N Do you have the right to live and work in the UK? Y N Do...
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