Apply online securely - London Quality Care Services

Job Application Form

Title Full name Date of birth Place of birth Nationality National Insurance number Address Telephone number Email address Driving licence Licence issued in / country Access to a car for work Languages spoken

Availability Availability notes

Reference 1

Name Relationship / position Organisation Email Telephone Permission to contact Address

Reference 2

Name Relationship / position Organisation Email Telephone Permission to contact Address Criminal record declaration Do you have any criminal convictions, cautions, warnings or bind-overs that are not protected under the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975?

Health Declaration and Medical Fitness Form

This confidential information supports safe recruitment and workplace health decisions.

GP / practice name GP telephone Health declaration Consent to contact GP if required Consent to medical examination if required

Equal Opportunities Monitoring Form

This information is kept separate from recruitment decisions.

Age range Gender / sex Ethnic origin Disability Religion or belief Sexual orientation I understand this monitoring information is kept separate from recruitment decisions. I confirm the information I have provided is true and complete.

Application form completed. On the live secure backend this will be saved for HR and generate separate Job Application, Health Declaration and Equal Opportunities records.