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MEDCOM NORTHERN IRELAND APPLICATION FORM

cloud_uploadUpload an Official ID
Position Applied Foryour full name
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Your Full Nameyour full name
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Which Part Of NI Do You Live?your full name
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Do You Driveyour full name
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Data Protection Statement

The personal information (data) collected on this form, and on the attachments, (which includes the collection of sensitive personal data) are collected for the purposes of recruitment, personnel administration (for new employees) and monitoring. Unless you direct otherwise (for example in a situation where you would like this Application kept on file for future vacancies) the Application Forms (and attachments) of unsuccessful applicants will be destroyed after 6 months. It is the policy of the Agency to protect, and keep secure, all personal data collected. All personal data is processed for the purposes of recruitment, and, in the case of successful Applicants, for the satisfactory administration of their employment, and for no other purpose.

The personal information (data) collected on this form, and on the attachments, (which includes the collection of sensitive personal data) are collected for the purposes of recruitment, personnel administration (for new employees) and monitoring. Unless you direct otherwise (for example in a situation where you would like this Application kept on file for future vacancies) the Application Forms (and attachments) of unsuccessful applicants will be destroyed after 6 months. It is the policy of the Agency to protect, and keep secure, all personal data collected. All personal data is processed for the purposes of recruitment, and, in the case of successful Applicants, for the satisfactory administration of their employment, and for no other purpose.

Equality of Opportunity Statement

The Agency’s Equal Opportunities Policy covers all employees, or potential employees, and embraces the principle that all people shall be treated equally, regardless of their age, gender, ethnic origin, nationality, colour, religion, marital status, sexual orientation, religion or belief, disability, or offending background.

Which Of The Following Applies to You
Titleyour full name
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Surnameyour full name
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Maiden Nameyour full name
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Previous Surnamesyour full name
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Previous Surnamesyour full name
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Addressyour full name
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Previous Surnamesyour full name
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Phone Homeyour full name
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Phone Workyour full name
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Phone Mobileyour full name
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Nationalityyour full name
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National Insurance Numberyour full name
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Date Of Birthof appointment
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May We Contact You at Work ?
Name Of Next Of Kin To Be Contacted During Emergency
First Nameyour full name
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Last Nameyour full name
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Addressyour full name
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Post Codeyour full name
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Phone Homeyour full name
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Post Codeyour full name
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Phone Mobileyour full name
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Relationshipyour full name
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Formal Education & Qualifications
Name of School/College/University and Locationyour full name
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Date Of Attendance
From Dateof appointment
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To Dateof appointment
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Course of Study/Qualification(s) gained e.g. GCSE’s, “A” levels, NVQ, Degree etcmore details
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Grademore details
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Employment History
Name & address of Employermore details
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From DateEmployment
date_range
To Dateof appointment
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Position held and brief summary of duties and responsibilitiesmore details
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Reason for leaving/Last salary or wagemore details
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Position held and brief summary of duties and responsibilitiesmore details
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Name & address of Employermore details
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From DateEmployment
date_range
To Dateof appointment
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Reason for leaving/Last salary or wagemore details
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Name & address of Employermore details
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From DateEmployment
date_range
To Dateof appointment
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Position held and brief summary of duties and responsibilitiesmore details
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Reason for leaving/Last salary or wagemore details
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Training – eg. Manual handling, CPR, infection control, first aid etc, (please provide certificates)
Details of training Hospital/establishmentmore details
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From DateEmployment
date_range
To DateEmployment
date_range
Courses takenmore details
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Attainmentmore details
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Details of training Hospital/establishmentmore details
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From DateEmployment
date_range
To DateEmployment
date_range
Courses takenmore details
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Attainmentmore details
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Details of training Hospital/establishmentmore details
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From DateEmployment
date_range
To DateEmployment
date_range
Courses takenmore details
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Attainmentmore details
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References
References References are normally taken up for candidates selected for interview. Give details of the names/addresses of two work-related Referees. One of the Referees should be your current employer, or if presently unemployed or self-employed, your last employer
First Nameyour full name
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Last Nameyour full name
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Addressyour full name
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Post Codeyour full name
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Telephone Numberyour full name
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Positionyour full name
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Relationship to Youyour full name
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May We Contact The Above Person Now
First Nameyour full name
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Last Nameyour full name
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Addressyour full name
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Post Codeyour full name
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Telephone Numberyour full name
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Relationship to Youyour full name
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Positionyour full name
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May We Contact The Above Person Now
Confidentiality Declaration
Registration implies acceptance of our code of confidentiality. In the course of your duties you may have access to confidential information about your clients. On no account must information relating to identifiable client be divulged to anyone other than the manager of the agency. You should not disclose ANY information to your family, friends or neighbours. If you are worried by any information you have obtained and consider that you should talk about it to someone else MAKE AN APPOINTMENT TO SPEAK IN PRIVATE TO YOUR MANAGER. Failure to observe these rules will be regarded as serious misconduct which could result in removal from the agency register
Rehabilitation of Offenders Act 1
As a general rule, no-one need answer questions about spent convictions. However this general rule does not apply to specified professions, employments and occupations. By virtue of the Rehabilitation of Offenders Act 1974 (Exceptions) (Amendment) Orders, the exemption rule does not apply to:
a) any employment or other work which is concerned with the provision of health services and which is of such a kind as to enable the holder of that employment or the person engaged in that work to have access to persons in receipt of such services in the course of his normal duties, or
b) any employment or other work which is concerned with the provision of care services to vulnerable adults and which is of such a kind as to enable the holder of that employment or the person engaged in that work to have access to vulnerable adults in receipt of such services in the course of his normal duties
One or both of the above apply to work with the Agency, and covers all occupations. You are therefore requested to provide details of all convictions, including those which would otherwise be considered as “spent”. All employment applications will be considered carefully, and the disclosure of a conviction does not imply that this employment application will be rejected.
Records will be checked via the Criminal Records Bureau procedures
Criminal Records – Disclosure Certificate
Access Northern Ireland (ACCESSNI) have issued a Code of Practice regarding Disclosure Information, a copy of which is available upon request. A Disclosure Certificate (standard or enhanced) will be requested from ACCESSNI which will detail all convictions, including those which would otherwise be “spent”, as well as details of cautions, reprimands or final warnings. You will be advised of the type of certificate being requested, and asked to give your approval to this application. The Disclosure Certificate will only be requested in the event that you are successful in your application for employment.
Disclosure: Is there any reason why you cannot work in a regulated activity (care)
If yes please state the reasonmore details
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