Join Us – Thistle Nursing

To join us, please apply online by filling the form below or you can download Application-form.pdf and email the filled in form to admin.tns@thistlenursing.co.uk

PLEASE COMPLETE IN BLOCK CAPITALS

PERSONAL DETAILS

Title

First Names

Nationality

NI Number:

Expires:

Grade:

Current Address:

Street AddressStreet Address Line 2CityState / Province / RegionCountry

Home Phone:

Area Code

Phone Number

E-mail:

Surname

DOB:*

Passport No:

NMC/HPC NUMBER:

Profession:

Speciality:

Previous Address:

Street AddressStreet Address Line 2CityState / Province / RegionCountry

Mobile Phone:

Area Code

Phone Number

I confirm that I am entitled to work in the UK and will provide Thistle Nursing Services with the relevant original documents in accordance with the Asylum and Immigration Act.

Please tick:

Next of Kin Details

Title:

Relationship:

email:

Do you hold a full driving license? :

Car Owner? :

How far are you willing to travel for work? :

Full Name:

Phone:

Area Code

Phone Number

Address (Including postcode): :

Street AddressStreet Address Line 2CityState / Province / RegionPostal / Zip CodeCountry

How did you hear about us?:

I have read and understood Thistle Nursing Services OPT OUT OF 48 HOUR WORKING AGREEMENT (which is available upon request) and I hereby consent that the working week limit shall not apply to my assignments. I understand that I can end this agreement by giving the Employment Business 14 days’ notice in writing.

Print Name

Signed:

Date:

Signature

Formal Education and Qualification

Name of School/University:

Dates of attendance:

Qualifications

Grades:

Employment History

Name & Address of Employer:

Dates of employment:

Position held and duties:

Fitness to Practice

Have you been or are you currently subject to any fitness to practice proceedings by an appropriate licensing or regulatory body in the UK or any other country?

Pick a choice:

Yes

If Yes, please provide information on a separate sheet detailing the nature of the proceedings undertaken, including approximate date of proceedings, country where proceedings were undertaken and the name and address of the licensing or regulatory body concerned.

References

Name:

First

Last

Telephone:

Area Code

Phone Number

Address:

Street AddressStreet Address Line 2CityState / Province / RegionCountry

emailaddress:

Capacity Known:

Name:(1)

First

Last

Telephone:(1)

Area Code

Phone Number

Address:(1)

Street AddressStreet Address Line 2CityState / Province / RegionCountry

emailaddress:(1)

Capacity Known:(1)

Confidentiality and Declaration

Registration with Thistle Nursing Services 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 any other person.

If you 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 manger.

Failure to observe these rules will be regarded as a serious misconduct which could result in removal from the agency register.

I have read and understood the above and I agree to abide by the contents therein.

Signed1:

Signature1: