Registration Form

Personal Details

Availability & Access

Employment History

Educational Qualification

Health and Fitness to Work

At NYS nursing we strongly advice Vaccination

Have you been vaccinated for the following? Please give details

Are you physically in good health and have you suffered from/ Do you suffer from any of the following conditions?

References

Please list below the names, addresses & contact details of 3 referees whom we can approach in confidence to vouch for you. There should be two from your last employer and at least one from an employer in a Care environment (Not Related to You)

Referee 1

Referee 2

Referee 3

Experience Assessment

Please indicate below any of the areas that you have experience in. This will help us to find suitable assignments for you.

Other: Please List

Your Present circumstance(s)

Please read all the following statements carefully and tick the one that applies to you

Student Loan

Equal Opportunities

The organisation is committed to a policy of equal opportunities for all and requires all employees to abide by and adhere to this general principle and to the requirements of the Code of Practice laid down by the Equal Opportunities Commission and the Commission for Racial Equality. In particular in this organisation:

(a) Discrimination on the grounds of race, colour, ethnic or national origin, religion, class, disability, special needs, on grounds of sex or marital status or membership or non-membership of a trade union will not be practiced or tolerated

(b) The organisation expects all employees, of whatever grade or authority, to abide by and adhere to this general principle.

(c) Staff will be promoted, employed and treated fairly on the basis_ of their ability and merits and accordingly to their suitability and no one will be disadvantaged by a condition or requirement, which is not justified by the genuine needs of their job or of the proposed job

(d) The organisation is committed to challenge any form of discrimination it encounters

(e) In order to provide equal employment and advancement opportunities to all individuals, employment decisions at the organisation will be based on merit, qualifications and abilities

(f) Employees or service users with questions or concerns about any type of discrimination in the organisation are encouraged to bring these issues to the attention of the Nurse Manager or Managing Director.

(g) Any breach of this policy should be reported to the Nurse Manager or to a senior, responsible member of organisation staff; breaches will be dealt with through the organisation's disciplinary procedures.

Recruitment of Ex-Offenders

As an organisation using the Criminal Records Bureau (CRB) Disclosure service to assess an applicants' suitability for positions of trust, NYS Nursing Agency complies fully with the CRB Code of Practice and undertakes to treat all applicants for positions fairly. It undertakes not to discriminate unfairly against any subject of a Disclosure on the basis of a conviction or other information revealed.

NYS Nursing Agency is committed to the fair treatment of its staff, potential staff or users of its services, regardless of race, gender, religion, sexual orientation, responsibilities for dependants, age, physical/mental disability or offending Background.

We do not discriminate against ex-offenders and they will receive fair treatment throughout the recruitment process.

At interview, or in a separate discussion, we ensure that an open and measured discussion takes place on the subject of any offences or other matter that might be relevant to the position. Failure to reveal information that is directly relevant to the position sought could lead to withdrawal of an offer of employment.

We make every subject of a CRB Disclosure aware of the existence of the CRB Code of Practice and make a copy available on request. Having a criminal record will not necessarily bar you from working with NYS Nursing Agency Ltd. This will depend on the nature of the position and the circumstances and background of your offences.

I confirm that I have read and aware of this policy.

I certify that to the best of my knowledge, all the information provided on this form is correct. I understand that any misrepresentation or withholding of relevant information on this form will be sufficient to invalidate this application and / or terminate any employment which may have begun.