Job Application

Please confirm your career history details for the last 10 years. Please list using most recent first.

Have you ever suffered from any of the following:

Application requires 2 professional references. It is essential that you have had professional dealings with both of your references within the last 2 years.

In this Agreement the following definitions apply:- “Assignment” means the period during which the Temporary Worker is engaged in services to a Client. “Client” means the person, firm or corporate body that has engaged the services of the Temporary Worker. “Employment Business” means Crown Medical Services. “Temporary Worker” means a Qualified Nurse, care assistant or other Temporary Worker. “Working Week” means an average of 48 hours each week as calculated over any 17 week period.

The Working Time Regulations of 1998 state that a Temporary Worker shall not work on an Assignment with a client in excess of the Working Week unless they agree in writing that this limit should not apply. The Temporary worker, by signing the declaration below, agrees that the Working Week shall not apply to their Assignments. The Temporary Worker can end this Agreement at anytime by giving the Employment Business 14 days notice in writing. After the 14 day notice period has expired the Working Week shall apply immediately. It should be noted, that any notice ending this Agreement does not mean that a Temporary Worker has ended an Assignment with a Client. These laws are governed by English Law and are subject to the jurisdiction of the English Courts.

I have read and fully understand the above OPT OUT AGREEMENT. I hereby consent that the Working Week limit shall not apply to my Assignments. I understand that I can end this Agreement by giving the Employment Business 14 days notice in writing.

Rehabilitation of Offenders Act

Due to the nature of the work for which you are applying, this post is exempt from the provisions of section 4.2 of the rehabilitations of offender’s act 1974 (exemption order 1975). Applicants are therefore, not entitled to withhold information about convictions which for other purposes are ‘spent’ under the provisions of the act and in the event of employment. Failure to disclose such convictions could result in dismissal or disciplinary action. Any information given will be completely confidential and will be considered only in elation to an application for positions in which the order applies, and should be entered at the end of any particulars you give in support of your application. A copy of our written policies is available upon request. A criminal record will not necessary be a bar to obtaining a position.

With an enhanced disclosure, under section 4.2 of the rehabilitation of offenders act 1974 (exemption order), all previous cautions, warnings and convictions will always be detailed regardless of how long ago. Any conviction, caution, reprimand will require a written statement of each and every event and how it does not affect your suitability for the role you are applying for.

I confirm that the information I have provided in support of this application is complete and true and understand that knowingly to make a false statement could be a criminal offence.

I consent to Crown Medical services checking the details I have provided against the various data sources in order to verify my identity and process the application. These details may be recorded and used to assist other organisations for identity verification purposes such as the CRB, regulatory bodies such as NMC or GSCC.

Crown Medical Services retains the right to hold this application and any other data required to process this application (whether in the UK, European Union or elsewhere) and keep for as long as necessary in line with the data protection act.

On receipt of a satisfactorily completed application form, Crown Medical Services will provide/send the following:-

1. Assist you with your DBS application for an enhanced DBS. The charge for this will be £58.39 (cheques to be made payable to Crown Medical Services Ltd).

The Working Time Directive requires that a worker’s average working time must not exceed 48 hours per week unless the worker agrees in writing to exceed the limit. Please sign the declaration below in order that we may lawfully employ you if your hours exceed 48. Please note that by signing this Opt-Out you are not committing to a working week of more than 48 hours, but rather allowing yourself to be offered assignments that could take you over this threshold.

Please note l wish to be paid gross for assignments with Crown Medical Services. I will take account of my own income tax and national insurance contributions. If I have not provided my self assessment number it is because this is my first year of self assessment. Once the Inland Revenue