Please complete the form below to apply for a position with us. First Name Middle Name Last Name Phone Number Email Date of Birth Nationality Please upload a copy of your Passport Document* Please upload copies of your Right to work in the UK Right to work share code. N.I Number* Please Upload Proof of N.I* What Role are you applying for ? Mental Health Nurse Healthcare Support Worker Nurse Do you have a Current DBS? Yes No If yes, Please enter DBS Number Please attach copy of DBS Please Capture Photo for your ID Badge Current Address* Please upload two proof of address Emergency Contact Name Emergency Contact Address Emergency Contact Number Start Date Do you have any experience working with the following Residential Home Supported Living Placement Nursing Home Community Care Upload Resume Upload Copies of Training Certificates References Bank Details I Authorize Watergate Healthcare to pay my wages into the above account Yes No Do you have any health issues or disabilities that will prevent you from carrying out your duties as a Healthcare Professional to a satisfactory standard? No Yes Rehabilitation of Offenders Act 1974 In view of the nature of the work for which you are applying, this post is exempt from the provision of 2.4(2) of the Rehabilitation of Offender Act 1974 by virtue of the Rehabilitation of Offenders Act (Exceptions) Order 1975. Applicant are, therefore, not entitled to withhold information about convictions, which for other purposes are “spent” under the provision of the Act and, in the event of employment, any failure to disclose such convictions would result in dismissal. Any information given will be completely confidential and will be considered only in relation to this application. Have you ever been convicted? No Yes Submit Application
