Online Registration – Wyse Care Ltd

Name*

Title

First

Last

Date of Birth*

day

/

month

/

year

Address*

Street Address Street Address Line 2 City Postcode Country

Email*

Phone*

Nationality*

Do you have the right to work in the UK? *

Yes

No

Please provide your share code to prove your immigration status

NI Number*

Are you Fully Vaccinated? *

Yes

No

Do you have an Online DBS ?

Yes

No

Online DBS Certificate Number (if any)

Have you ever been dismissed from any other employment?*

Yes

No

Registration No (e.g. NMC reg. No.)

Expiry Date

Employer Name(1)*

Date From / Date To (1)*

Work Address (1)*

Street Address Street Address Line 2 City Postcode Country

Employer Name(2)

Date From / Date To (2)

Work Address (2)

Street Address Street Address Line 2 City Postcode Country

Type of reference*

Reference 1*

Title

First

Last

Referee Address 1

Street Address Street Address Line 2 City Postcode Country

Referee 1 Phone

Referee 1 Email

Reference 2*

Title

First

Last

Referee Address 2

Street Address Street Address Line 2 City Postcode Country

Referee 2 Phone

Referee 2 Email

Next of Kin *

First

Last

Next of Kin Address

Street Address Street Address Line 2 City Postcode Country

Next of Kin Phone

Has any Social Service Department or Police Service ever conducted an enquiry or investigation into any allegations or that you may pose an actual or potential risk to children or vulnerable adults?*

Yes

No

Have you ever been convicted of any offence relating to children or vulnerable adults?*

Yes

No

Have you ever been the subject of any disciplinary procedure or been asked to leave employment or voluntary activity due to inappropriate behavior towards a child or vulnerable adult?*

Yes

No

If you have answered ‘YES’ to any of these questions above, please give details.

Rehabilitation of Offenders- Because of the nature of the work for which you are applying, this post is exempt from the provisions of Section 4(2) of the Rehabilitation of Offenders Act 1974, by virtue of the Rehabilitation of Offenders Act 1974 (Exemption) Order 1975. Applicants are therefore not entitled to withhold information about convictions, which for other purposes are spent under the provisions of the act and in the event of employment any failure to disclose such convictions could result in dismissal or disciplinary action by the employer. All Successful candidates will be required to obtain an enhanced disclosure report from the Disclosure and Barring Service. Have you ever been convicted of a criminal offence, or been subject to any confidential discharge, bind overs or caution.*

Yes

No