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Duty Time:*
Preferred type of work:*
Name:*
FirstLast
Address:*
Date of Birth:*
Contact Numbers:
Home:*
Work:*
Mobile:*
Pager:
Email*
Next of Kin:
Name*
FirstLast
Relationship*
Address:*
Phone:*
Current place of work:
N.I Number:
Work Information
Do you require a work permit:
If yes, please attach a copy
Attach work permit copy:
Have you been police checked:
If yes, please attach copy of original report
Attach copy of original report:
Do you speak fluent english:
NMC number (If applicable)
Expiry Date:
Please supply the names of two professional referees and position held.
1. Name
FirstLast
1. Address:
1. Phone:
2. Name
FirstLast
2. Address:
2. Phone:
Upload a CV:*
Health
Name of own doctor:
Phone:
Address:
Have you attended a doctor in the past year?
Details:
Medical History
Are you on any treatment:
Chronic eye trouble
Eye injury
Do you use glasses:
Ear problem:
Ear discharge:
Hearing defect:
Hay fever:
Frequent colds:
Asthma:
Bronchitis:
Heart trouble:
High blood pressure:
Kidney trouble:
Back trouble - causing time off work:
Foot trouble:
Black outs:
Epilepsy:
Fainting attack:
Giddiness:
Skin trouble:
Skin rash:
Skin sensitivity to foods/drugs:
Diabetes:
Nervous or mental disorder:
Depression:
Stomach disease:
Headaches including migraine:
Varicose veins:
Details of Immunisations
BCG. Vaccine:
Hepatitis B. Vaccine:
Measles Vaccine:
Rubella Vaccine:
Equal Opportunity Monitoring
CRS is determined positively to address the issues of equal opportunities in its employment and in service access and provision. CRS policy objective is to achieve equality of treatment regardless of race, colour, nationality, ethnic or national origin, age, marital status, gender, sexual orientation, religion, political beliefs, trade union membership, disability, carer responsibilities and relevant conditions. This statement of intent is made to provide a corporate policy basis for all employees.
I am
I have dependents ( financially dependant children, non-working spouse/partner, elderly relatives, sick relatives or partner )
- Yes
- No
I have a disability
I am
Age group
Essential Information In Order To Process Your Application
National Insurance No.
Do you need a work permit?
- Yes
- No
If yes, please upload copy
Attach work permit copy
Attach passport/immigration papers copy
CONFIDENTIALITY: Information concerning patients, their treatments and their affairs is strictly confidential and must not be disclosed to any authorized person(s). You are reminded that any breach of confidentiality may result in termination of your engagements with the CRS and could result in civil action for damages.
REHABILITATION OF OFFENDERS ACT 1974:The post which you are applying is exempt from Section 4(2) of the Rehabilitation of Offenders Act 1974 by virtue of the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975.
Have you therefore had any conviction or cautions, whether or not considered spent?
- Yes
- No
If yes, please contact us and let us know.
THE WORKING TIME REGULATIONS 1998: Please note that the above set of Regulations set out new provisions governing average working time limit for workers. By signing this application, you thereby agree to the exclusion from the conditions of service of CRS of any implied working time limits as referred to in such regulations.
PROTECTION OF CHILDREN: Staff with access to children must give his/her permission in writing for a Police check to be carried out. I, the below named give permission for a police check to be carried out.
Surnames:
Other Names:

Call Us Now: ++44 (0) 20 8646 1637

Register With Us

Contact Numbers:

Next of Kin:

Work Information

Health

Medical History

Details of Immunisations

Equal Opportunity Monitoring

Essential Information In Order To Process Your Application