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You must complete all parts of the Application Form. Please read the form before attempting to complete it.

Personal Details

Your Details

Do you hold a current British driving license?

Do you require a work permit to work in the UK?

Preferred shift:

Next of Kin Details


Please give information about qualifications gained relating to the role you are applying for. Include your grade and where you recieved the qualification from. Please note if your application moves on to the inverview you may be asked to provide proof of these.

Qualified Nurses/Training

Please give information about any additional training undertaken relating to the role you are applying for. Include what the training was, the date you received it, and where you recieved it. Please note if your application moves on to the interview stage you may be asked to provide proof of these.

Previous Employment

Present/Most Recent Employer

Previous Employer

About You


Please note here the names, addresses and telephone numbers of two persons from whom we may obtain both character and work experience references. References from your current employer will not be sought without your authority.

Please provide the names and addresses of three referees, one of whom should be your current or most recent employer and one other previous employer. The other should be a personal referee (not family).

Reference 1

Reference 2

Reference 3

Other Information

Are you facing any criminal prosecutions?

Do you have any spent/unspent convictions or cautions under The Rehabilitation of Offenders Act 1974?

Have you been dismissed from any employment?

Have you ever been or are you currently going through any investigation or disciplinary action?

What period of sickness and/or unauthorised absence have you had in the last two years?

Medical Questions

Have you ever suffered or are suffering from any of the following?

Are you currently in good health?

Do you have a physical, mental or health related impairment that has a substantial and long-term adverse affect on your ability to carry out normal day-to-day activities?

Can we make any reasonable adjustments to avoid you being at a disadvantage in the work place?

Have any health-related reasons in the last two years kept you away from work or prevented you from seeking work?

Have you ever been dismissed from employment because of health-related reasons?

Equal Opportunities

The Rehabilitation of Offenders Act 1974 (Exceptions Order 1975)

By virtue of the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975, the provisions of Section 4.2 of the Rehabilitation of Offenders Act do not apply to any employment which is concerned with the provision of health services and which is of such a kind as to enable the holder to have access to persons in receipt of such services in the course of his/her normal duties. Your answer to the following question should include any “spent” convictions. Please do not be under the prelude that your application would be unsuccessful should you hold any convictions. If your application is successful an enhanced disclosure is required, the cost of which will be met by Axel Bond Care. Should we/you terminate your employment within twelve months of commencement you will be liable to pay back the full cost of the disclosure fee.


(Please read this Carefully before signing this application)

I agree that the information provided in this application form may be processed by the employer in relation to my application for this post to assist in the decision making process. I further expressly agree that, should it be necessary to validate any of the information provided herein, the employer may release this information for verification purposes. If successful in my application it is agreed that any information provided will be retained by the employer in a secure confidential file and the contents only used for necessary business purposes subject to my express consent for disclosure where necessary.