Work for Us – Local Medics & Ambulance Service

Name *

First

Last

Grade *

Please select the option that is most applicable to yourself. We will need you to upload copies of your qualification certificates or portfolio sign-offs later on.

Registration Number *

Date of Birth *//

Address *

Address Line 1

City

State / Province / Region

Postal Code

Country

Layout

Email *

Phone *

Layout

Passport

Click or drag files to this area to upload. You can upload up to 2 files.

Proof of Address *

Click or drag files to this area to upload. You can upload up to 2 files.

Bank Statement, Utility Bill, Mobile Phone Contract, Council Tax Bill dated within last 3 months.

Driving Licence

Click or drag files to this area to upload. You can upload up to 2 files.

Please include Front & Back of Driving Licence

Any Additional Evidence

Click or drag files to this area to upload. You can upload up to 2 files.

Deed-poll/Change of Name Document, Right to Work, etc

Layout

Primary Qualification Held *

Date Obtained *//

Primary Qualification Held *

Click or drag a file to this area to upload.

Secondary Qualification Held

Date Obtained//

Secondary Qualification Held

Click or drag a file to this area to upload.

Driving Qualification Held

Date Obtained//

Driving Qualification Held

Click or drag a file to this area to upload.

Layout

Do you have an Enhanced DBS? *

DBS Number

Is your DBS on the Update Service *

Have you any convictions (other than spent convictions under the Rehabilitation of Offenders Act 1974? *

Please upload a copy of your DBS here.

Click or drag files to this area to upload. You can upload up to 2 files.

We require your last 5 years of work history.

If self-employed please put in your trading name and how long you have been

Layout

Employer 1

From

Reason for Leaving

Line Manager or HR Name

First

Last

Employer 2

From

Reason for Leaving

Line Manager or HR Name

First

Last

Layout

Employer 3

From

Reason for Leaving

Line Manager or HR Name

First

Last

Employer 4

From

Reason for Leaving

Line Manager or HR Name

First

Last

Layout

Employer 5

From

Reason for Leaving

Line Manager or HR Name

First

Last

Employer 6

From

Reason for Leaving

Line Manager or HR Name

First

Last

Layout

Name *

First

Last

Relationship to you

Phone

Layout

Referee 1 *

First

Last

Relationship to you *

Where do you know this person from? *

Company Name *

Referee 1 Email *

May we contact this person for a reference *

We will only contact your reference after we have checked your DBS and qualifications. When we do contact them we will make it clear that this is a Zero-Hours/Bank Self Employed role.

Referee 2 *

First

Last

Relationship to you *

Where do you know this person from? *

Company Name *

Referee 2 Email *

May we contact this person for a reference *

We will only contact your reference after we have checked your DBS and qualifications. When we do contact them we will make it clear that this is a Zero-Hours/Bank Self Employed role.

Updating preview…

This is a preview of your submission. It has not been submitted yet!
Please take a moment to verify your information. You can also go back to make changes.

I confirm I am not a manager, owner, or in a relationship with the manager or owner of, or have a business interest in another Event Medical Company in the UK. *

Tick Here to Confirm
I am unable to confirm this

If you are unable to confirm this then a member of our HR team will be in touch to find out what company you are involved with and the involvement you have prior to processing your application.

Declaration. I declare that the information given in this form is complete and accurate.

I understand that any false information or deliberate omissions will disqualify me from employment or may render meliable to summary dismissal.

I understand these details will be held in confidence by the Company, in compliance with data protection legislation and as set out in the Company’s Employee Privacy Notice.

I undertake to notify the Company immediately of any changes to the above details.

Please press submit below to indicate your agreement.

Layout