Contact us today:      Phone: (0117) 956 4555 Mobile: 07791546979
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  • Personal Details

  • LanguageLevel of Proficiency 
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  • Emergency Contact

  • Right to work in the UK

  • Work Preferences

  • From
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  • Further Education

    Where applicable, please include details of examinations which have been or are about to be taken but results of which are not yet available.
  • College/UniversityQualificationGrade/Class (if applicable)Date obtained 
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  • Voluntary Eperience

  • Professional Qualifications

  • Awarding Body/InstitutionQualificationGrade/Class (if applicable)Date obtained 
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  • Employment History

    Please provide details of all your employment starting with the most recent / current position, and any gaps for the last 10 years. College leavers must provide details of vacation employment.
  • Employer/OrganisationDates From-ToPosition/GradeSalary/Hourly rateReasons for leavingDetails of duties & responsibilities 
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    Please provide as much detail as possible
  • Please use the space above to give any other information you consider to be relevant, including reasons why you consider yourself a suitable candidate for this position.
  • References

    Please supply the names and addresses of at least two people (not relatives) whom we may contact for references. One of these should be from your most recent employer and be from someone of a senior capacity.
  • Current EmployerNamePositionAddressPhoneEmail 
  • Previous EmployerNamePositionAddressPhoneEmail 
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  • Discliplinary & Criminal Issues

    Under the rehabilitation of Offenders Act 1974, certain previous convictions can be regarded as “spent” under certain circumstances, but this does not apply to persons seeking employment in Registered Care Homes. The information will be treated in confidence and only taken into account where, in the reasonable opinion of Courtfield Healthcare Ltd, the offence is relevant to the post for which you are applying. Failure to declare a conviction may require us to exclude you from our register or terminate an assignment if the offence later comes to light.
  • Declaration & Confidentiality Agreement

    You are not required to work for more than an average of 48 hours per week. Only sign the above statement if you wish to be able to work for more than 48 hours per week.
  • Equal Opportunities Monitoring Form

  • Please complete in full Do agree that I may work for longer than the average 48 hours per week. If I change my mind I will give my employer and/or agency not less than one weeks notice in writing to end this agreement.
  • For the sole purpose of monitoring our policy, as stated above, please complete the following:
    (This information will only be used to support your staff development needs.)
  • Your Ethnic Origin

    Please indicate your ethnic group

About Courtfield

Of equal importance to us we take pride in caring for our agency staff and our clients with a prompt and professional service. Thank you for choosing Courtfield Healthcare Ltd as your service provider and please be assured of our commitment to you at all times.
Contact Us

Contact us

Suite 4 & 5, 77 North Street
Downend, Bristol
BS16 5SE

Phone: (0117) 956 4555
Mobile: 07791546979
E-mail: manager@courtfieldhealthcare.co.uk


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Contact Us Today         Phone: (0117) 956 4555 Mobile: 07791546979

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