Kingdom Health

Application Form

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    Position Applied For:

    Employment Type (e.g., Part time, Full time):

    Personal Details

    Title:

    First Name:

    Middle Name(s):

    Date of Birth:

    Gender:

    Mobile Number:

    Passport Number:

    National Insurance Number (Mandatory):

    Surname:

    Surname at Birth (if different):

    Forename at Birth (if different):

    Town of Birth:

    Nationality:

    Home Telephone Number:

    Passport Issue Date:

    UK Driver’s License Number (if applicable):

    If you have been known by any other names, provide details below:

    Your Current Address

    1st Line of Address:

    Town/City:

    Country:

    2nd Line of Address:

    Province/County:

    Postcode:

    At this address since (MM/YYYY):

    Right to Work

    Are you a United Kingdom National?

    YesNo

    If answered NO above, provide SHARE CODE to prove right to work. Use the following address to obtain the share code: https://www.gov.uk/prove-right-to-work

    Safeguarding (ROA 1974) – Ex-Offender’s Declaration

    Are you currently bound over or do you have any current UNSPENT convictions that have been issued by a Court or Court-Martial in the United Kingdom or in any other country?

    YesNo

    Do you have any current UNSPENT police cautions, reprimands, or final warnings in the United Kingdom or in any other country?

    YesNo

    Nursing Registration and Licensing

    Registration Body:

    Registration Date:

    Expiry Date:

    NMC Pin Number:

    Date of Last Revalidation:

    Years of Experience:

    Specialised Areas (tick all that apply):

    Community Nursing (e.g., CPN, District Nurse)Theatre NursingRespiratory WardNon-Invasive Ventilation (Nippy 4 Airway), Cough Assist, etc.Tracheostomy Care (e.g., dressing, suctioning, full tube change)PEG/RIG CareWound Care and Dressing ManagementAdministering MedicationsMonitoring Vital SignsPatient Education and Family SupportPost-surgical Care

    C.V And Supporting Statement

    Upload CV

    Upload Supporting Statement