We like our workers to be willing to work flexibly across the week and need to know when other commitments mean you could not be available to work.

Please tick which days you prefer to work:

3. Education/Qualifications

High School

High School

To ensure the safety of our clients an Enhanced DBS (formerly CRB) check must be completed for all positions. A criminal record will not necessarily be a bar to obtaining a position with Raynes Healthcare. If a check is returned and reveals any information, this will be discussed with the applicant. The Director(s) will make a decision as to whether the offer of employment should be withdrawn.

Please give the detail of two references. We will take up professional references once you have been interviewed and provisionally offered a post. Please make sure that you have given the full contact details of your referees so that this does not delay processing reference requests.

If you have no employer references, we will take up references with named individuals at colleges where you have studied, or people who know you in a professional capacity. Please do not put down family members or people you live with as referees.

Will you be working as ‘Pay As You Earn’ (PAYE), or paid through a Limited or Umbrella Company? Please give the details of your Ltd or Umbrella Company provider (if applicable). Ltd Company workers will need to provide copies of certificate of incorporation and VAT registration certificate.

The Working Time Regulations 1998 state that you are unable to work in excess of an average of 48 hours per week (calculated over a 17-week period) unless agreed with the El-Bliss (Ltd) Personnel that this limit should not apply.

El-Bliss (Ltd) wishes to have an agreement with you, which will apply until terminated by notice:

1. The average 48 hour work limit will not apply to you.
2. This agreement may be terminated by yourself by giving El-Bliss (Ltd) 4 weeks written notice.

If you accept this proposal please sign below. This section of the application form will then be a record of this agreement between you and El-Bliss (Ltd).

Statement to be Signed by the Applicant

Please complete the following declaration and sign it in the appropriate place below. If this declaration is not completed and signed, your application will not be considered.

I agree that El-Bliss (Ltd) can create and maintain computer and paper records of my personal data and that this will be processed and stored in accordance with the Data Protection Act 1998.

I confirm that all the information given by me on this form is correct and accurate and I understand that if any of the information I have provided is later found to be false or misleading, any offer of employment may be withdrawn or employment terminated.

El-Bliss (Ltd) is an equal opportunities employer and will ensure that no job applicant or employee receives less favourable treatment particularly on the grounds of sex, race, colour, nationality, ethnic origin, marital status, disability, sexuality, age, religious belief, political belief, trade union activity, responsibility for dependants, employment status or HIV status.

Please complete this form and return it with the main Application Form to assist El-Bliss (Ltd) in monitoring its Recruitment and Selection process. In addition, the information will form part of the employment record for the successful applicant and will be used by El-Bliss (Ltd) for later equal opportunities monitoring purposes throughout the period of employment.

This form is not made available to those conducting the recruitment interview.

PLEASE NOTE: If you falsify any information on this form, or fail to mention anything relating to your health which may later come to light, you may be liable for disciplinary action including immediate suspension

You are required to complete the Health Self Declaration Assessment below which must be signed and returned to El-Bliss (Ltd) agency prior to the start date.