The Nurse-Owned Agency of Choice
for Nurses and Support Staff

Supporting Hospitals, Residential Homes, Children’s and Independent Care Facilities throughout the UK

Rehabilitation of Offenders Act 1974
Have you ever been convicted by the courts, cautioned, reprimanded or given a final warning by police?

If yes, please give details:


Are you aware of any police enquiries being undertaken following allegations made against you which may have a bearing on your suitability for the post applied for?

If yes, please give details:


Please note that you will be required to complete a DBS disclosure check.

Relevant Experience:  Please note any further information you feel may be in useful in support of your application.  You may also attach a CV, as part of Step 3 below, if you wish.

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Many of our clients ask to see a CV in advance and this will help to speed-up the application process so we can find out more about your experience.  You do not, however, need to upload a CV at this point.

Registration Date

3

Upload your own CV file, if you wish, to support your Application (in Word or PDF format)

Full Name

Home Postcode

Contact (Mobile) Number

Email Address

2

Complete the Application Details Below

School/College/Uni. Attended

Dates From/To

Qualifications Gained

Employment History (10 years):
Company Name and Address

Date From:
(Month/Year)

Position Held /
Job Title

Date To:
(Month/Year)

Referee’s Position/Title

Your Current/Most Recent Company Name

Ref 1 Name (Manager)

Email Address:

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Company Name and Address

Ref 2 Name (Manager)

Email Address:

Referee’s Position/Title

Company Name and Address

Ref 3 Name

Email Address:

Referee’s Position/Title

Declarations before submission of application

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Please complete the words/
numbers shown

Address

Date of Birth

For Registered Nurses Only:

Please Note: We will contact you by email and text, so please make sure both your email and mobile are correct.

Click this button to submit your entire Application to Key Care & Support...

Please tick to confirm that your employment history covers a full 10 years (or your employment and full time education combined cover a full 10 years) and that you have given this detail in Months and Years (only years will not be accepted)

If you have used any private-style email addresses for referees (for example Gmail, Yahoo, Virgin.net etc.) please state why here.  We are required to use professional emails but do understand that some organisations/individuals still use email addresses provided by other organisations.

References:  Please give the name of three professional referees, one of whom must be a Manager at your current or most recent employer.  Please note that email addresses must be professional/work emails (ie. Hotmail/Gmail etc. type emails are not acceptable).  References are sought by email, therefore please make sure these are accurate otherwise they may be referred back to you.

Name of Contact

Address

Relationship

Telephone

Post Code

Next of Kin Details

Application Online for Nurse and Support Staff Positions

Complete the three steps below to Submit your Application in detail and we will contact you regarding interview…

Apply to Key Care & Support

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1

Enter your Contact Details and Role Applied-For

Role Applied For

NMC Registration No.

Sector / Specific Role*

* Click Here for Sector Specific Information…

If you are currently studying to be a Registered Nurse, we may be able to offer you additional benefits. Please enter here the Nursing Qualification you are undertaking, at which University and in which year:

If there are any gaps in your 10 year employment history, please detail here the reasons (for example, childcare from mm/yy to mm/yy, time out travelling from mm/yy to mm/yy etc.)