Application Form

Please fill in the form below.

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    Personal Details

    Are you a United Kingdom (UK), European Community (EC) or European Economic Area (EEA) National?


    Next Of Kin Details

    Equality Act 2010

    Under the Equality Act 2010 the definition of disability is if you have a physical or mental impairment that has a ‘substantial’ and ‘long-term’ adverse effect on your ability to carry out normal day to day activities. Further information regarding the definition of disability can be found at:
    Reasonable adjustments will be made available should you be invited to interview. According to the definition of disability do you consider yourself to have a disability?
    YesNoPrefer not to say

    Driving Record

    Own Transport

    Do you have any driving-related prosecutions/fixed penalties/endorsements or similar currently pending?

    Have you ever been disqualified from driving?

    Have you ever had insurance refused?


    Training Courses Attended Or Completing

    Employment History

    Please record below the details of your FULL employment history since leaving education, with your current or most recent position first.

    Employment History One

    Salary / Rate:

    Employment History Two

    Salary / Rate:

    Employment History Three

    Salary / Rate:

    Supporting Statement






    You must provide references from your two most recent employers. Please inform your referees that we will be contacting them as this usually speeds up the process. You will NOT be able to commence work until we have received two satisfactory references.
    If you have not been employed before, please discuss the matter with us.





    Please sign below to confirm that we may contact your references prior to employment:


    Nash Health Care Ltd aims to promote equality of opportunity and is committed to treating all applicants fairly regardless of ethnicity, disability, age, gender or gender re-assignment, religion or belief, sexual orientation, pregnancy or maternity and marriage or civil partnership. Nash Health Care Ltd undertakes not to discriminate unfairly against applicants on the base of a criminal conviction or other information declared.
    Answering ‘yes’ to the question below will not necessarily prevent your employment.
    This will depend on the relevance of the information you provide in respect of the nature of the position and the circumstances.

    Are you currently bound over or do you have current UNSPENT convictions that have been issued by a Court or Court-Martial in the United Kingdom or in any other country?


    Nash Health Care Ltd will only collect data for specified, explicit and legitimate use in relation to the recruitment process. By signing this application form you consent to Nash Health Care Ltd holding the information contained within this application form. If successfully shortlisted, data will also include shortlisting scoring and interview records. We would like to keep this data until the vacancy is filled. (We cannot estimate the exact time period, but we will consider this period over when a candidate accepts our job offer for which we are considering you). When that period is over, we will either delete your data or inform you that we would like to keep it in our database for future roles. We have privacy policies that you can request for further information. Please be assured your data will be securely stored by the Registered Manager and only used for the purposes of recruiting for this vacant post. You have a right for your data to be forgotten, to rectify or access data, to restrict processing, to withdraw your consent and to be kept informed about the processing of your data. If you would like to discuss this further or withdraw your consent at any time please contact the Registered Manager or Data Protection Officer on 01452 346 576


    The information in this application form is true and complete.
    I agree that any deliberate omission, falsification or misrepresentation in the application form will be grounds for rejecting this application or subsequent dismissal if employed by Nash Health Care Ltd. Where applicable, I consent that Nash Health Care Ltd can seek clarification regarding professional registration details.

    Please prove you are human by selecting the Cup.

    Please ensure you complete the application form in full as we cannot accept CVs.

    Please note that no applicant will be unfairly discriminated against. This includes discrimination on account of age/cultural/religious/political belief, disability, ethnicity, gender, race, relationship status, sexual orientation, and/or Trade Union membership or stewardship.

    If you have any special requirements to support you to complete this form (e.g. the need for large print or additional time) please let us know.