The fields marked as '*' are mandatory

Position applied for*

Personal Details

Title*

First Name*

Last Name*

Address*

Landline*

Mobile*

Other

E-mail Address*

Date of Birth*

Right to Work in the UK

We are required by law to ensure that anyone working for us is entitled to live and work in this country.

Are you legally entitled to work in the UK? *

National Insurance Number*

In line with the Asylum and Immigration Act 1996 we have to ask for proof of your right to work in the U.K. Therefore if you are invited for an interview you must bring with you original documents of identification showing that you are a British Citizen (e.g. passport); or that you have the right of abode in the U.K.; or show proof of your right to work in the U.K. During the interview the document(s) will be checked to ensure that you are their rightful owner and a photocopy will be taken of the necessary areas of the document. An offer of employment will not be made if document(s) are not produced or if they are unsatisfactory.

Employment History

This must span back 5 years. Please detail any gaps.

Employment History 1

Job title*

Grade*

Description of duties*

Start Date*

End Date

Address*

Reason for leaving*

Employment History 2

Job title

Grade

Description of duties

Start Date

End Date

Address

Reason for leaving

Employment History 3

Job title

Grade

Description of duties

Start Date

End Date

Address

Reason for leaving

Employment History 4

Job title

Grade

Description of duties

Start Date

End Date

Address

Reason for leaving

Note:If you wish to update more employment history details, please update them under the additional information section.

Qualifications

Qualification 1

Name / Course*

Grade*

Date achieved*

Qualification 2

Name / Course

Grade

Date achieved

Qualification 3

Name / Course

Grade

Date achieved

Qualification 4

Name / Course

Grade

Date achieved

Note:If you wish to update more qualifications, please update them under the additional information section

Medical Registration

Body

Registration number

Expiry

References

Please supply details of two people we can contact for a reference. One of these should be your current / last employer.

Reference 1

Name*

Occupation*

Email*

Contact number*

May we contact this ref?*

Reference 2

Name*

Occupation*

Email*

Contact number*

May we contact this ref?*

Additional information, personal qualities and attributes

Please use this section to add any extra work experience, qualifications, and extra additional information to support your application.*

What qualities and skills do you have that will enable you to undertake the duties of the post for which you are applying for. You should outline both your experience and work achievements.*

How did you hear about A B Medical Services (UK) Limited?

Do you have your own medical kit (If so, please state what you have)*

Driving

Please complete this section if you are applying for a vacancy where you are required to drive / wish to drive company vehicles. Please bring the original copy of your driving licence (both counterparts) to the interview with you .

For insurance reasons all applicants are required to be:
• Over 21 years of age.
• Held a full and valid driving license for at least 2 years.
• Driven in the UK for at least 24 months.
• Hold no more than 6 endorsement points.
• Subject to approval by our corporate insurers.

Please be advised we will carry out bi-annual checks to ensure your driving licence continues to comply with our insurance obligations. Failure to notify us of changes or to comply with our insurance obligations may lead to the termination of your employment with us.

Do you hold a current valid manual driving license?*

License Number

Expiry

Held for over 2 years?

Have you driven in the UK for at least 12 months?

Do you have any current endorsements?

Have you ever been banned from driving

Are you an advanced driver?

Criminal Convictions

A B Medial Services Aims to promote equality of opportunity for all with the right mix of skills and potential. Owing to the nature of our work there are a number of positions to which the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975 apply* Employees are subject to both an enhanced Disclosure and Barring Service check and ISA Adult First Check being undertaken on for a position and thereafter on a regular basis for the duration of their employment. Criminal records will be taken into account for recruitment purposes only when the conviction is relevant. Having a conviction will not necessarily bar you from employment. This will depend upon the circumstances and background to your offences(s). .We are unable to employ individuals who are listed on the ISA Adult First check.
Please refer to the tables below to determine whether any convictions you have are spent (passed the rehabilitation period) or unspent (within the rehabilitation period). You are obliged to tell us about all spent and unspent convictions.
In accordance with the information above:

Do you have any convictions, cautions, reprimands or final warnings which would not be filtered in line with current guidance?*

Tax & National Insurance

I understand that A B Medical Services (UK) Limited has bank positions available. I will be fully liable to declare my income from A B Medical Services (UK) Limited and I will be fully liable for any tax and national insurance contributions.

Fitness

I am physically and mentally fit to do the post I am applying for. If no, please enter details in the additional box at the end of this application. YesNo

Declaration of Application

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 (Exception) Order 19. Applicants are, therefore, not entitled to withhold information about convictions which for other purposes are ‘spent’ under the provisions of the Act, and, in the event of recruitment, any failure to disclose such convictions could result in dismissal or disciplinary action by the Company. Any information given will be completely confidential and will be considered only in relation to an application for positions to which the Order applies.
I also confirm that the information contained in this application is true and correct to my knowledge.

Please write your name in the box below to confirm the above.*

Data Protection Agreement

Please click below to consent to A B Medical Services (UK) Ltd holding data about this form and /or inquiries made hereafter in line with the current Data Protection / GDPR legislation. We are registered as a data controller / processor with the UK ICO. A B Medical Services (UK) Ltd will never use your data without consent and will never share this data without explicit consent. Please refer to our full Data Protection policy.