Your Details
First Name
Last Name
Gender
Male
Female
Non Binary
Prefer to Self Describe
Prefer not to say
Date of birth
Address & Contact Details
Address
Email
Phone
Country
City
Post Code
Religion
Buddhist
Hindu
Muslim
Sikh
Christian
Jewish
Rastafarian
None
Other
Prefer not to say
Next of Kin
Relationship
Contact number
Position You're Applying For
Position applied for
Nurse
Carer
Senior Carer
Support Worker
Other
NMC Number
Expiry date
Shift preference
Day shift
Night shift
Mixt Shift
Full time
Part time
Professional Qualifications and Experience
What is the highest qualification you've achived?
Doctoral degree
Master's degree
Bachelor's degree with Honours
Non-Honours Bachelor's Degree
Higher National Diploma
Higher National Certificate
A-level, National Diploma, BTEC
NVQ
GCSE
Skills for Life
Other
Name of school/college/university
Name of qualification obtained
Date qualification was obtained
Training
Name of last training course completed
Name of training body course was obtained from
Date course was completed
Willing to attend training as / when required
Employment History
Please add details of the past five years work history, starting with your current or most recently held position. You must state reasons for any breaks in employment.
Name of employer
Address of employer
Position held and duties
Start date
Leaving date
Reason for leaving
Details
References
Please supply names and contact addresses of at least two references who are healthcare professionals and preferably hold a position more senior to your own.
One reference must be from your current or most recent place of employment.
Name of current or most recent employer
Contact name of line manager for reference
Professional email address of line manager for reference
Position held
Date started
Leaving date
Reason for leaving
Bank Details
Please provide PAYMENT DETAILS where you'd like to receive payment for your shifts.
National Insurance Number
Account Holder
Account number
Sort Code
Bank Name
UTR Number (If applicable for self employed)
Company Name (If applicable for LTD)
Company Number (If applicable for LTD)
Eligibility
Before you can work with Star Care Team, we will need to verify and take a copy of your original ID documentation as evidence of your right to work in the UK in accordance with Home Office guidance on the prevention of illegal working. Please pick ONE of the following option.
Do you have permission to work in the U.K?
I DO have permission
I do NOT have permission
Please read the following statement:
"Because of the nature of the work for which you are applying, this post is exempt from the provisions of Section 4(2) of the Rehabilitation of Offenders Act, 1974, by virtue of the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975 and the Rehabilitation of Offenders Act 1974 (Exceptions) (Amendment) Order 1986.
Applicants are, therefore, obliged to disclose information about any convictions which for other purposes would be regarded as ‘spent’ under the provisions of the Act”. Failure to disclose such convictions could result in dismissal or disciplinary action by the employing organisation. Any information given will be confidential and will be considered only in relation to any post to which the conviction applies.
Have you at any time received or had pending a court conviction in the UK or overseas? If yes, please give details.
If Yes, please provide details
Are you aware of any police enquiries undertaken following allegations made against you, in the UK or overseas?
If Yes, please provide details
Data Protection
Working Time Regulations
Equal opportunity for all work seekers is of paramount importance at Star Care Team. As such, Star Care Team committed to a policy of equal opportunity, and shall adhere to non discriminatory practices at all times on all aspects of operation including recruitment and placement, and to unlawful or undesirable discrimination. Every worker will be treated equally regardless of race, ethnic or national origin, colour, sex, sexual orientation, disability, marital status, age, religion, political beliefs, offending history or membership or non-membership of a trade union and we require commitment from all staff and agency workers to respect and act in accordance with the policy. Assessment of candidates will solely be based upon the candidates merits, qualification and ability to perform the relevant duties required by a particular vacancy.
I have read and I understood the above and I agree to abide by the contents therein.
Do you consider yourself to have a disability under the Equality Act?
*The definition of disability according to the Equality Act 2010 is: "A physical or mental impairment which has a substantial and long term adverse effect on his or her ability to carry out normal day to day activities". A long term effect is one that has lasted 12 months, is likely to last 12 months or, is likely to last the rest of the person’s life.
If Yes, please provide additional information.
Data Consent
I hereby declare to the best of my knowledge that the information given above, including any supporting documents is true and correct. I consent to my personal data and profile being forwarded to clients. I consent to references being passed on to potential employers. I consent to the processing of personal data, and for any enquiries to be made to confirm all matters concerning my application, and employment such as qualification, dates of employment, experience, Disclosure and Barring Services check, and health checks, and for the release by other people and organisations for that information might be necessary for that purpose. I understand that false information might lead to your dismissal from the Star Care Team Flex platform. If during the course of a temporary assignment, the Client wishes to employ me direct, I acknowledge that Star Care Team will be entitled either to charge the client an introduction/transfer fee, or to agree an extension of the hiring period with the Client (after which I may be employed by the Client without further charge being applicable to the Client). I understand that acceptance on to the Star Care Team Flex platform may only be granted after relevant checks are made, satisfactory references are received and I have attended a Face to Face interview. I hereby consent to pre-employment screening checks will take place. I consent for such checks to be performed and acknowledgement that any failure to provide accurate information may result in my application not being taken forward. I consent to a 3rd Party Audit, complete DBS Check, DBS Update Service Checks, to retain DBS on file, to obtain references, to complete PIN Checks, Right to Work and Identity Checks, to complete Training record checks, to complete Occupational Health checks, to complete Qualification Checks, Confirmation of receipt of AWR information (including Day 1 Rights)
I have read and I understood the above Statement and Declaration and I agree to abide by the contents therein
Date of consent
Health self declaration
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 immediate suspension from the platform. You are required to complete the Health Self Declaration Assessment below which must be signed and returned to Star Care Team prior to the start date Do you have any illness/impairment/disability (physical or psychological) which may affect your work, your own health, safety and welfare, or that of others?
If Yes, please provide additional information.
Are you having, or waiting for treatment (including medication) or medical investigation at present?
If Yes, please provide additional information.
Do you think you may need any adjustments or assistance to help you to do the job?
If Yes, please provide additional information.
Do you have any of the following?
A cough which has lasted for more than 3 weeks
Unexplained weight loss
Unexplained fever
Had tuberculosis (TB) or been in recent contact with open TB
None of the above
If Any, please provide additional information.
As a health care worker, you are under ethical and legal duties to protect the health and safety of the individuals in your care. All information disclosed will be processed in accordance with the requirements of the Data Protection Act.
Have you ever had chickenpox/varicella?
Can you provide documented evidence of immunity to measles, mumps and rubella?
Have you had a BCG vaccination in relation to tuberculosis?
Have you had a Hepatitis B test in the last 5 years?
If Any additional information is needed, please give details below
Please provide proof of your immunisation record This can be obtained from your GP or local travel clinic.
SUBMIT