YOUR APPLICATION PACK Step 1 of 6 Name Position Recommended by PRIMARY COMPANY YOU WISH TO JOIN: WNA Healthcare HMR I agree that the information I provide in this application pack can be used by both sister companies: WNA Healthcare and HMR Medical and Nursing Service. The reason for this is to provide me with more opportunity and diversification in the work I can potentially be offered. Next step YOUR PERSONAL DETAILS Step 2 of 6 TitleTitle Miss Mrs Mr Ms Surname Forename Middle name Maiden name Marital status D.O.B. Address Address 2 Town County Postcode Landline phone Mobile phone E-mail NEXT OF KIN DETAILS Full name Relationship Address Address 2 Town County Postcode Landline phone Mobile phone E-mail NATIONALITY DETAILS WNA / HMR do not employ any nurse / carer requiring a work permit or with limited leave to remain in the UK. Nationality Native language National insurance number Eligibility to work in UKEligibility to work in UK I am eligible to work in the UK and do not require a work permit. I am already in possession of a work permit to work in the UK. I need to obtain a work permit to work in UK Other Work permit expiry date NMC DETAILS NMC number NMC expiry date NMC part(s) of register NMC part(s) expiry date Professional indemnity insurance union TRANSPORT DETAILS Transport detailsTransport Car Public Transport Previous stepNext step YOUR EMPLOYMENT HISTORY Step 3 of 6 Date from mm/yy Date to mm/yy Employer’s name and address Position Reason for leaving Date from Date to Employer’s name and address Position Reason for leaving YOUR PROFESSIONAL CONDUCT Have there been any proceedings of medical negligence of professional misconduct against you and have you ever been suspended or dismissed Yes No YOUR REFERENCE DETAILS Name Position Address Address 2 Town County Postcode Phone number Fax number E-mail More references Previous stepNext step YOUR CLINICAL EXPERIENCE Step 4 of 6 Please check box in the relevant experience / years you have in each field, or leave blank if not applicable. GENERAL EXPERIENCE 0-12 months 1 year + GENERAL EXPERIENCE 0-12 months 1 year + Medicine Learning Disabilities Surgical Domicilary Care Mental Health Nursing Homes Prisons Observation Records HCA ONLY 0-12 months 1 year + HCA ONLY 0-12 months 1 year + Urinalysis Toileting BM Testing (Diabetes) Mobility Personal Hygiene Nutrition Others Record Keeping HOSPITAL EXPERIENCE 0-12 months 1 year + HOSPITAL EXPERIENCE 0-12 months 1 year + A&E Paediatrics A&E Cardiac Paediatrics Chemotherapy Palliative Care Clinics PCIU Community Plastic Surgery Coronary Care Unit Radiology Diagnostic Imaging X-ray Recovery Dialysis Renal Elderly Care SCBU Endoscopy Surgical General wards Theatres Gynaecology Triage Health Visitor Urology High Dependency Unit NICU Walk in Centres Nurse Practitioner ITU - Intensive Care Unit Occupational Health Learning Disabilities ODP Medical Health Oncology Mental Health Orthopaedics Midwifery Neonatal Previous stepNext step YOUR PAYE / LTD BANK ACCOUNT DETAILS Step 5 of 6 We pay wages directly into a bank account. BANK DETAILS Account holder name Company name (if applicable) Name of bank Address Address 2 Town County Postocde Sort code Account number READ ALL THE FOLLOWING STATEMENTS CAREFULLY AND CHECK THE BOX THAT APPLIES TO YOU. I wish to be paid trought a Ltd. Company and enclose details. (You will be paid as P.A.Y.E. until you provide all your documentation to WNA / HMR) Yes I am on P.A.Y.E. (Please enclose P45 if we are your main employer) Yes PLEASE NOTE THAT WITHOUT THE CORRECT DETAILS YOU WILL NOT BE PAID ON TIME AND THIS SHEET WILL BE RETURNED BACK TO YOU. OFFICE USE HCA NVQ RGN RN2 RMN Auto pay number Previous stepNext step AVAILABILITY QUESTIONNAIRE Step 6 of 6 1. Where did you hear about us?Internet search Social media Recommendation Job Center Leaflet Other 2. Would this be your main job or second income?Main Job Secondary Income 3. How many shifts would you like to work per week?1-2 2-4 4+ 4. What is your preferred shift pattern?Early Late Night Long Day No-Preference 5. Please detail dates of any time off or planned holiday. 6. Please choose your preferences for establishments. Hospitals Community Nursing Homes Prisons South South East South West Midlands North Other / specific locations Don't miss out! Please tick this box if you would like to receive regular updates and the latest job vacancies from WNA Healthcare. Please see our Privacy Policy for full Ts & Cs. Previous step Submit
