Welcome (1)
Personal Section (2)
Employment Section (3)
Reference Section (4)
Self Disclosure Section (5)
Health Declaration (6)

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FRENDY HEALTHCARE SERVICES APPLICATION PACK

Dear Applicant,

Thank you for selecting FHS24. Our team is committed to ensuring that your work requirements are met whenever possible. We specialise in providing high-quality locum Nurses and HCA’s to a wide range of Private and Charitable healthcare providers.

FHS24 success depends on how well we work together. To achieve this there have to be agreed rules, guidelines and standards of conduct for all; these are fully explained in the Staff Handbook in conjunction with our Policies and Procedures. Copies of these are available on request and shortly via our website www.fhs24.co.uk.

The amount of work that we receive depends not only on us, but also on your performance, therefore we have some basic expectations of you, which are listed in your terms of engagement. These include:

• Making sure you arrive on time for your placement, or preferably 5 minutes early. If you are running late, you must ring the office or out of hours mobile as soon as possible and advise us of this so that we can let the client know.

• You represent FHS24 at the client, so please ensure that you perform your expected duties professionally and willingly at all times.

• If you cannot make your shift, you must give adequate notice in order for you to be replaced.

• FHS24 will only pay on receipt of an authorised timesheet. Weekly payments are made provided the timesheet arrives by Tuesday 12.00pm for payment on Friday. Please check with your consultant that your timesheet has been received. Payment is made 1 week in arrears.

If for any reason you’re unhappy with any aspect of the service that FHS24 provide, please feel free to contact our Office Team on 01935 388586.

Please take some time before starting your first placement with us to familiarise yourself with your Terms and Conditions of Employment. This information should provide you with all of the reference material you may require, but please feel free to ask your FHS24 consultant if there is anything that you are unsure of, as we are always here to help.

Thank you and welcome to FHS24.

Yours sincerely,

Section A - Personal Information

Personal Details

Title *

Surname *

First Name *

Previous Names

(if applicable)

Address

House Number, Street Name

Town *

Post Code *

Country *

Passport Details

What Is Your Visa Status? *

Contact Information

Please double check to ensure your contact details are correct.

Mobile Number *

Home Tel. Number

(Just incase we can't reach you on your mobile)

Email Address *

(Please make sure you provide an email you have access to)

Next Kin Information

Please provide information of someone we can contact when we are unable to reach you.

Title *

Surname *

First Name *

Relationship *

(who is this person to you)

Address *

House Number, Street Name

Town *

Post Code *

Country *

Mobile Number *

(Please provide a phone number)

Email Address

First Contact

How did you first get to hear about FHS24? *

Advert Referral Website Others...

Job Choice

What Job Are You Applying For? *

This will determine if you are required to fill out Section-B

Section B - Qualification and Training

Nursing Details * (Section B is optional)

NMC/HPC Registration No

Part(s) of Register

Expiry Date

dd-mm-yyyy

Training Details

Please send copies of diploma/degree and any other relevant certificates. Originals to be presented at interview!

Name of University/College

Qualitfication

Date Started

dd-mm-yyyy

Date Qualified

dd-mm-yyyy

Specify Qualification

Training Providers and Expiration Date

Do you have any of the training listed below? If "Yes", provide details with expiry date. If "No", go to next page. It is a mandatory requirement that the following training is updated annually.

Training provider for Emergency First Aid

Expiry Date

dd-mm-yyyy

Training provider for Moving & Handling

Expiry Date

dd-mm-yyyy

Training provider for Fire Safety Training

Expiry Date

dd-mm-yyyy

Training provider for Health & Safety

Expiry Date

dd-mm-yyyy

Training provider for Infection Control

Expiry Date

dd-mm-yyyy

Training provider for Deprivation of Liberty (DOLS)

Expiry Date

dd-mm-yyyy

Training provider for Confidentiality

Expiry Date

dd-mm-yyyy

Training provider for COSHH

Expiry Date

dd-mm-yyyy

Training provider for Equality and Diversity

Expiry Date

dd-mm-yyyy

Training provider for Safeguarding of Vulnerable Adults

Expiry Date

dd-mm-yyyy

Training provider for Food Hygiene

Expiry Date

dd-mm-yyyy

Training provider for Medication Training

Expiry Date

dd-mm-yyyy

Training provider for Person Centred Care

Expiry Date

dd-mm-yyyy

Training provider for Challenging Behaviour

Expiry Date

dd-mm-yyyy

Training provider for Epilepsy

Expiry Date

dd-mm-yyyy

Section C - Employment Info Section

Employment (1)

Please supply details of your full employment history starting with your most recent position first.

Employer's Name

Start Date

(Date you started work there)

End Date

(Date you ended work there)

Address

(Enter the address of the place you worked)

Position and Reason For Leaving

Add More Employment History? (+)

(You may add more employment history)

Section D - Reference Section

Current Employer * (Please provide "Current Employer" details and any of the other 2 below)

Current Employer's Company Name

Name

Position

Address

Post Code

Phone

Are You Happy For Us To Contact This Employer?

Previous Employer

Previous Employer's Company Name

Name

Position

Address

Post Code

Phone

3rd Reference * (Can be a character referee)

Company Name

Name

Position

Address

Post Code

Phone

Working Time Regulations

The Working Time Regulations 1998 require employers to limit the number of hours worked by any employee to 48 hours per week, unless an employee agrees to work outside of that limit.

FHS24 wish to have an agreement with candidates which includes: -

The Working Time Regulations (48 hours working week) will not apply to candidates
Candidates may terminate the agreements by providing FHS24 with 4 weeks written notice

Under the regulations, FHS24 will keep records relating to candidates working time and will do so regardless of candidates’ acceptance of the proposed agreement above.

Section E - Self-Disclosure of Criminal Background

Confidential

Please complete this self-disclosure section and bring it with you on your selection or interview day.

Title *

First Name *

Last Name *

Middle Name

Date of Birth *

dd-mm-yyyy

Place of Birth *

Address *

House Number, Street Name

City *

Postal Code *

State/Province/Region *

Country *

Do You Have A Previous Name?

Please select an option below

Previous Name Question selection

Yes No

NOTE: It is a statutory requirement for any employee to make a full disclosure of any criminal record, however trivial it may seem.
Prior to commencement of employment you will be required to complete an enhanced Disclosure and Barring Service (DBS) form, formally known as a Criminal Records Bureau check which FHS24 will arrange. On receipt of this, any declaration of criminal record – self declared or reported by the DBS – is likely to be discussed in confidence by a representative of the Company, a satisfactory outcome of any such discussions is essential.
The requirement to declare any criminal record is mandatory, making a false or inaccurate statement will be treated as misconduct and/or an act of dishonesty. Applicants who fail to make a declaration will not be offered a place

Do you have any convictions, cautions, reprimands or final warnings that are not "protected" as defined by the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975 (as amended in 2013)?

Please select an option below

Do you have any conviction record

Yes No

Please look at the following links below if you require further information:

- DBS filtering guidance
- Rehabilitation of offenders,

Section F - Vaccination History Section

We require the following:

1. COVID-19: Proof that you have done your coronavirus vaccination.

Have you done Covid-19 vaccination? *

Yes No

2. Tuberculosis: A certificate from your doctors’ surgery or occupational health department of a positive BCG scar or record of a positive skin test.

Have you done Tuberculosis vaccination? *

Yes No

3. . Mumps, Measles and Rubella: A certificate of vaccination or blood test result showing your immunity levels.

Have you done Mumps, Measles and Rubella vaccination? *

Yes No

4. Varicella: A certificate of vaccination or blood test result showing your immunity levels.

Have you done Varicella vaccination? *

Yes No

5. Hepatitis B: You must provide a copy of the most recent pathology report showing titre levels of 100lu/l or above, or antigen status if titre level is below 100lu/l.

Have you done Hepatitis B vaccination? *

Yes No

6. Hepatitis B Surface Antigen Proof of a negative result.

Have you done Hepatitis B Surface Antigen vaccination? *

Yes No

Upload Your CV

Please send us your resume

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FRENDY HEALTHCARE SERVICES APPLICATION PACK

Section A - Personal Information

Personal Details

Passport Details

Contact Information

Next Kin Information

First Contact

Job Choice

Section B - Qualification and Training

Nursing Details * (Section B is optional)

Training Details

Training Providers and Expiration Date

Section C - Employment Info Section

Employment (1)

Section D - Reference Section

Current Employer * (Please provide "Current Employer" details and any of the other 2 below)

Previous Employer

3rd Reference * (Can be a character referee)

Working Time Regulations

Section E - Self-Disclosure of Criminal Background

Confidential

Do You Have A Previous Name?

Do you have any convictions, cautions, reprimands or final warnings that are not "protected" as defined by the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975 (as amended in 2013)?

Section F - Vaccination History Section

Upload Your CV

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