Apply with FirstCol

Online Application

Completion Time: 30 minutes.

Thank you for your interest in joining FirstCol. It is easy to register with us. Please fill in all sections of this application form. You will receive an immediate response to acknowledge your application and out recruitment team will contact you with an interview date.

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Title*
Surname*
First name*
Middle Name(s)
Previous or Maiden Name
Home Phone *
Mobile Phone *
Work Phone
D.O.B. *
UK National Insurance No.
Nationality*
Email Address*
Address
House No*
Street
City*
State/Province
Postcode
Country*
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Drivers Licence
Do you have a current Driving Licence that is valid for use in the UK? *
Please enter the licence number.
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Position Applied For
Preferred Employment Type *
Job title
Agency worker role applied for
Preferred Employment Type *
Suppoter Workers/HCAs
Doctors
Allied Health Professionals
Cleaning/Kitchen
Other (Please Specifiy)
Membership of Professional Bodies

Please provide details regarding any relevant professional registrations or memberships. This information will be subject to a satisfactory check.

Professional Registration Status
Membership of Professional Bodies
Membership or Registration Type
Membership/Registration Number/PIN
Nursing and Midwifery Council (NMC)
Membership or Registration Type
Membership/Registration Number/PIN
Expiry/Renewal Date
General Medical Council (GMC)
Membership or Registration Type
Membership/Registration Number/PIN
Expiry/Renewal Date

If you are applying for a post that requires professional registration, you are required to further provide the following information:

Are you currently the subject of a fitness to practise investigation or proceedings by a licensing or regulatory body in the UK or in any other country?
If ‘YES’ to the above, please provide details of any investigations or proceedings you may be subject to.
Have you been removed from the register or have conditions been made on your registration by a fitness to practise committee or the licensing or regulatory body in the UK or in any other country?
If applicable, please provide details of any conditions you may have.
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Occupational Health Vaccination/Immunity History
GP Name
GP Address
House Name/No.
City
State
Post Code
Country*
Phone
Have you worked for or trained in the NHS before?
If ‘YES’ please give details below
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Right to Work in the UK

Under Immigration, Asylum and Nationality Act, we are required to check that all employees are eligible to work within the UK. Please tick ‘YES’ against the right to work category that is applicable to you and indicate which of the specified original documents you would be able to submit as proof of your right to work.

Are you a British Citizen or a citizen of the United Kingdom and Colonies having the right to work in the UK?
If ’YES’ to the above, which of the following original documents can you provide as confirmation?
Are you a national of European Economic Area (EEA) country or Switzerland?
If ’YES’ to the above, which of the following original documents can you provide as confirmation?
Are you allowed to stay indefinitely in the UK?
If ’YES’ to the above, which of the following original documents can you provide as confirmation?
Do you have a current document that indicates that you are allowed to stay in the UK and are allowed to do the type of work in question?
If ’YES’ to the above, which of the following original documents can you provide as confirmation?
If none of the above is applicable in your case, you must answer this question
What other type of visa or document do you currently hold that indicates that you are allowed to stay in the UK and are allowed to do the type of work in question? Type of visa/document and details of restrictions to employment or occupation in the UK?
Visa Start Date: (DD/MM/YY)
Visa Expiry Date: (DD/MM/YY)
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Education and Professional Qualifications

All relevant qualifications. Please also indicate subjects currently being studied. All qualifications disclosed will be subject to a satisfactory check.

University/College/School
Start Date
Date Completed
Qualification(s) Attained
Add more education and/or professional history *
University/College/School
Start Date
Date Completed
Qualification(s) Attained
Add more education and/or professional history *
University/College/School
Start Date
Date Completed
Qualification(s) Attained
Add more education and/or professional history *
University/College/School
Start Date
Date Completed
Qualification(s) Attained
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Training Courses Attended

Training courses that you have attended or details of courses that you are currently undertaking, together with the date completed or to be completed.

Course Name/Title
Training Provider
Duration
Date Completed
Add more training courses
Course Name/Title
Training Provider
Duration
Date Completed
Add more training courses
Course Name/Title
Training Provider
Duration
Date Completed
Add more training courses
Course Name/Title
Training Provider
Duration
Date Completed
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Employment History

Please record below the details of your full employment history since you finished full time education beginning with your current or most recent first. If required, please provide additional information in Section 11 regarding any gaps between all employment posts.

Job Title
Employer
Start Date
End Date
Business Type
Telephone
Employer Address
Reason for Leaving
Notice Period
Previous Employment 2
Job Title
Employer
Start Date
End Date
Business Type
Telephone
Employer Address
Reason for Leaving
Notice Period
Previous Employment 3
Job Title
Employer
Start Date
End Date
Business Type
Telephone
Employer Address
Reason for Leaving
Notice Period
Previous Employment 4
Job Title
Employer
Start Date
End Date
Business Type
Telephone
Employer Address
Reason for Leaving
Notice Period
Previous Employment 5
Job Title
Employer
Start Date
End Date
Business Type
Telephone
Employer Address
Reason for Leaving
Notice Period
Gaps in Employment History

Please explain any gaps between all employment posts since you finished full time education, beginning with the most recent gap.

Gap 1
Date Range - From
Date Range - To
Reason for gap in employment
Gap 2
Date Range - From
Date Range - To
Reason for gap in employment
Gap 3
Date Range - From
Date Range - To
Reason for gap in employment
Gap 4
Date Range - From
Date Range - To
Reason for gap in employment
Gap 5
Date Range - From
Date Range - To
Reason for gap in employment
Previous Dismissal from Employment
Have you ever been dismissed from employment?
If YES, please give details below including date(s), company and reasons for dismissal
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References

Please provide the names and full contact details of three people who have agreed to supply references to cover a period of three years employment and/or training history. Referees will be required to comment on your competence, personal qualities and suitability for the post. This may be your line/department manager, or someone in a position of responsibility for any work experience or placement undertaken. If you are a student or trainee this should include a teacher/tutor at your education institution. If you have not been in employment for over 3 years, then you should seek one reference from your last known employer and two Character/Personal reference from a person of standing within your community who knows you. Where you have not been in employment at all or it is genuinely not possible to obtain references from any of the sources outlined above, you must provide contact details of three personal acquaintances who would be willing to give a character reference. Personal acquaintances must not be related to you, or have any financial arrangement with you. Referees may be approached prior to interview, unless you indicate otherwise below.

Reference1
Type of Reference
Referee Title
Referee Forename(s)
Referee Surname
Referee Job Title
Relationship
Company Name
Company Address
City*
State/Province
Postcode
Country*
Telephone
Referee Email
Can the referee be contacted prior to interview?
Reference 2
Type of Reference
Referee Title
Referee Forename(s)
Referee Surname
Referee Job Title
Relationship
Company Name
Company Address
City*
State/Province
Postcode
Country*
Telephone
Referee Email
Can the referee be contacted prior to interview?
Reference 3
Type of Reference
Referee Title
Referee Forename(s)
Referee Surname
Referee Job Title
Relationship
Company Name
Company Address
City*
State/Province
Postcode
Country*
Telephone
Referee Email
Can the referee be contacted prior to interview?
Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975 (Amendment) (England and Wales) Order 2013

The position you are applying for has been identified as being an 'eligible position' under the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975 [the Exceptions Order] and, in certain circumstances, the Police Act 1997. As such, it meets the eligibility criteria for a standard or an enhanced disclosure to be requested through the Disclosure and Barring Service (DBS). Both standard and enhanced DBS disclosure certificates contain information about any convictions, cautions (including reprimands and final warnings) which are not 'protected' as defined by the Rehabilitation of Offenders Act 1974 (Exceptions Order) 1975 (as amended). Enhanced disclosures may also include other relevant police information where this is deemed relevant to the position you are applying for. The position has, in addition, been identified as a regulated activity under the Safeguarding Vulnerable Groups Act (2006) (as amended by the Protection of Freedom's Act 2012) and therefore an enhanced DBS disclosure will include information which is held on the Children's and/or Adults barred list(s), as applicable to the position. Please note that you do not need to tell us about convictions, cautions, warnings or reprimands which are deemed 'protected' or ‘spent’ under the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975 as amended by the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975 (Amendment) (England and Wales) Order 2013 - see notes above. You also are not required to tell us about parking offences.

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* Are you currently bound over, or do you have any convictions or cautions (including warnings and reprimands) which are not deemed 'protected' under the amendment to the Exceptions Order 1975, issued by a Court or Court- Martial in the United Kingdom or in any other country?
If YES to the above, please include details of the order binding you over and/or the nature of the offence, the penalty, sentence or order of the Court, and the date and place of the Court hearing.
Are you currently bound by any barring decision made by the Disclosure Barring Service (DBS) from working with children?
Are you currently bound by any barring decision made by the Disclosure Barring Service (DBS) from working with vulnerable adults?
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Copies of any proffessional certificates
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Data Protection Act 2018

PRIVACY NOTICE FOR JOB APPLICANTS, EMPLOYEES AND AGENCY WORKERS This form contains both your ‘personal data’ and ‘special categories of personal data’ (e.g. convictions and offenses) as defined by the Data Protection Act 2018 under the General Data Protection Regulation (GDPR) (EU) (2016/679). Your data will be processed by FirstCol Services Ltd ('FirstCol') exclusively for the purpose of recruitment, employment and/or finding you agency work. FirstCol protects any information disclosed within this form and ensures that it is not passed to anyone who is not authorised to have this information. If you consent to FirstCol collecting and processing your personal data in accordance with the terms stated in FirstCol’s Employee Data Protection and Privacy Notice, please tick the boxes below to confirm.

Your consent to processing or your data by FirstCol

Please read FirstCol’s Privacy Notice for Job Applicants, Employees and Agency Workers before you submit this form. Do not submit the form if you do not consent to processing of your personal data.

I confirm that I have read and understood FirstCol’s Employee Data Protection and Privacy Notice
I consent to processing my personal data by FirstCol as detailed in their Employee Data Protection and Privacy Notice.
Declaration

I certify that my answers and all the information that I have provided in this form are true and complete to the best of my knowledge. I agree that any deliberate omission, falsification or misrepresentation in the application form or interview will be grounds for rejecting this application or subsequent dismissal from employment. I authorise FirstCol Services Ltd to make any other enquiries they may feel necessary to support my application. Where applicable, I consent that FirstCol Services Ltd can seek clarification regarding my professional registration details where applicable.

I agree to the above declaration
Where did you see this vacancy advertised?
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