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Register As A Carer

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CQC Regulated Provider

DBS-Verified Carers

24/7 On-Call Support

UK-Wide Coverage

1. Personal Details

Title *

Name *

First

Last

Date of Birth *

Your Email *

Nationality *

National Insurance Number *

Have you ever been know by another name? *

Your Address *

Address Line 1

City

State / Province / Region

Postal Code

Country

Your Preferred Work Locations *

Telephone *

Mobile *

Do you hold a full driving licence? *

Do you have an Enhanced DBS certificate? *

Are you a Mental Health Nurse, Registered General Nurse or a Healthcare Assistant? *

Mental Health Nurse (RMN)
Registered General Nurse (RGN)
Healthcare Assistant or Support Worker

2. Education/Qualifications

School Attended *

Qualification Obtained *

Date Completed

School Attended *

Qualification Obtained *

Date Completed

School Attended *

Qualification Obtained *

Date Completed

School Attended *

Qualification Obtained *

Date Completed

3.Training & Training Courses

Training/Courses Attended *

Qualification Obtained *

Date Completed

Training/Courses Attended *

Qualification Obtained *

Date Completed

Training/Courses Attended *

Qualification Obtained *

Date Completed

Training/Courses Attended *

Qualification Obtained *

Date Completed

4. Employment History

Please list out your Work Experience over the last 3 years in Healthcare, ensuring that you explain any gaps.

Your Work Experience (Last 3 Years Starting from Most Recent). Ensure you explain any gaps in employment *

5. Other Experiences & Skills

Please provide a brief statement about yourself, your related experiences, skills and any other information related to you.

Other Experiences & Skills

Have you previously worked with Cygnet or Priory? *

Yes I Have
No I haven't

6. Health Questionnaire

Do you suffer from or have you ever suffered from any of the following conditions? Please select Yes or No.

Allergies *

Eczdema, dermatitis or skin problems *

Epilepsy? *

Hernia or Rupture? *

Mental illness (Including acute anxiety or medical depression)? *

Migraine? *

Rheumatsim or stiff joints? *

Serious backache, slipped disk, sciatica or back injury? *

Wrist, arm, shoulder or neck problems, repetitive strain injury (RSI)? *

Angina, heart probelms or circulatory disorders? *

Asthma? *

Bronchitis or chest infections? *

Diabetes? *

Stomach or intestinal disorders, ulcers? *

Tuberculosis (TB), Hepatitis, HIV/AIDS, or other infections? *

Any condition requiring long term medical help or treatment or medication on strict timetable? *

7. Health Declaration

I Concur

I have no reason to believe that my health will interfere with my ability to undertake the duties of the assignments for which I have applied, or affect my ability to attend work on a regular basis.

To the best of my knowledge and belief, the information given above is correct. I understand that if offered assignments and the information I have provided is false, I could be liable to dismissal.

8. Referees and Next of Kin

Please provide your two most recent employers as referees. If you have not been employed please give the name of the head of education or training establishment and/or the manager of a voluntary group for whom you have worked. Please provide the latest address and telephone numbers.

Employment Reference

Please provide details of your employment referee

Name *

Job title

Capacity known

Job Start Date *

Job End Date *

Their Address *

Address Line 1

City

State / Province / Region

Postal Code

Country

Telephone *

Referee's Email *

Employment Reference 2

Please provide details of a second employment referee

Name *

Job title

Capacity known

Job Start Date *

Job End Date *

Their Address *

Address Line 1

City

State / Province / Region

Postal Code

Country

Telephone *

Referee's Email *

Next of Kin

Next of Kin's Name *

Their Address *

Address Line 1

City

State / Province / Region

Postal Code

Country

Telephone *

Their Email *

9. Criminal Convictions

The nature of the work you are applying is exempt from Section 4(2) of the Rehabilitation of Offenders Act 1974 by virtue of the Rehabilitation of Offenders Act (Exceptions Order) 1975. This means that you must disclose any criminal convictions found against you., even if they might otherwise be regarded as spent. If "Yes", Please give details of the conviction(s) and date(s).

Has your employment ever been convicted of a criminal offence? *

10. Finance

The Details You Provide Will Be Useful To Effect Payment For Any Work You Undertake And For Compliance Or Tax Purposes

Account Name

Sort Code

Account Number

11. New Starter Declaration

Starter Declaration

Pick ONE of the following three statements

This is my first job since last 6 April and I have not been receiving taxable Jobseeker's Allowance, Employment and Support Allowance, taxable Incapacity Benefit, State or Occupational Pension.
This is now my only job but since last 6 April I have had another job, or received taxable Jobseeker's Allowance, Employment and Support Allowance, taxable Incapacity Benefit. I do not receive a State or Occupational Pension.
As well as my new job, I have another job or receive a State or Occupational Pension.

P45

I attach a copy of the P45 from my previous employer

12. Working Time Directive (WTD) Declaration

This agreement is drawn up under the Working Time Directive (WTD) 1998 and enters you into an agreement with SEED Consultancy Ltd to opt out of the 48 hours limit in respect of the total weekly average hours. The Regulations state that on average you should not be asked to work more than 48 hours per week. The average is calculated over a seventeen-week period.

The Declarations:

I agree that the 48 hour weekly limit specified in the Working Time Directive 1998 shall not apply in my case
I understand this agreement will apply from the date of signing this document
I am fully aware that I have a responsibility not to work hours so long that they may impair my efficiency or expose my colleagues or the public to risk
I understand that Seed Consultancy Ltd will keep a copy of this Agreement on my personnel file.
I understand that I must inform Seed Consultancy Ltd in writing if I wish to withdraw from this agreement
I understand that I am under no obligation to sign this Agreement.
I understand that by not signing this declaration I am agreeing to work less than 48 hours per week.

13. Upload All Your Documents (Upload CV Too) *

Click or drag files to this area to upload. You can upload up to 25 files.

Upload: (1) Right to Work- Passport Page/BRP (2) Training Certificate (3) DBS Certificates (4) Proof of Address 1 (5) Proof of Address 2 (6) Passport Photograph (7) Your CV

Register As A Carer

1. Personal Details

2. Education/Qualifications

3.Training & Training Courses

4. Employment History

5. Other Experiences & Skills

6. Health Questionnaire

8. Referees and Next of Kin

Employment Reference

Employment Reference 2

Next of Kin

9. Criminal Convictions

10. Finance

11. New Starter Declaration

12. Working Time Directive (WTD) Declaration

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