Job Application | Medicare Support

Step 1 of 7

14% Complete

Personal

Address

Position

Work Preferences

Confidentiality

Disclosure

Declaration

Step 1 of 7

Personal Details

Please provide your personal information exactly as you would like it recorded on your application.

Title *

Please select your title.

First Name *

Please enter your first name.

Middle Name

Last Name *

Please enter your last name.

Previous Name

If applicable.

Email Address *

This will also be used for communication regarding your application.

Please enter a valid email address.

Date of Birth *

Please enter your date of birth.

Password *

Use at least 8 characters.

Please enter a password of at least 8 characters.

Confirm Password *

The passwords must match.

Profile Photo

Upload your profile photo

JPG, JPEG, PNG or WEBP

Choose Photo

Change

Optional. Upload a clear recent photograph.

Step 2 of 7

Your Address

Please provide your current residential address.

Address Line 1 *

Please enter your address.

City *

Please enter your city.

Post Code

Country *

Step 3 of 7

Further Personal Details

Please provide the following additional information about yourself and the position you are applying for.

Nationality *

National Insurance Number

Mobile Number *

Please enter your mobile number.

Home Phone Number *

Please enter your home phone number.

What Position are you applying for? *

Nurse Care Worker Support Worker Care Coordinator HR and Office Administrator Accounts and Payroll Administrator Other

Please select the position you are applying for.

Step 5 of 7

Confidentiality Declaration

Please read the confidentiality declaration carefully before confirming your agreement.

Confidentiality Declaration

As a CQC-registered care provider, we are committed to protecting the privacy and dignity of the people who use our services. By applying to work with us, you agree to follow our confidentiality policy at all times.

During your work you may have access to personal or sensitive information about people who use our services, their families, or colleagues.

This information must be treated as strictly confidential and only shared with authorised staff when necessary for care or other legitimate professional purposes.

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

You must accept the confidentiality declaration.

Signature *

Type your full name as your signature.

Please enter your signature.

Date *

Please enter today's date.

Step 6 of 7

Enhanced Criminal Records Disclosure Information Sheet

Please read the following information carefully before continuing with your application.

Rehabilitation of Offenders & Criminal Record Checks

Disclosure of Convictions

Under the Rehabilitation of Offenders Act 1974, you are required to declare all convictions, including spent convictions as defined under the Act.

A conviction does not automatically prevent you from being considered; however, failure to declare any information will result in your application being withdrawn and may lead to further action. You are also required to inform us if you are convicted, cautioned, or have a hearing pending in the future.

Enhanced Disclosure

As this role involves contact with vulnerable adults, an enhanced disclosure will be required. This includes:

All spent and unspent convictions
Investigations without convictions
Local authority actions
Driving offences through a court of law
Ongoing criminal investigations

In rare cases, the police may provide confidential information directly to the employer which cannot be disclosed to you.

Important Notice

If your enhanced disclosure reveals any offences not declared on application, your application will be withdrawn from the recruitment process.

For further information on enhanced disclosures, please visit GOV.UK .

Step 7 of 7

Declaration

Please read the following declaration carefully before submitting your application.

The information supplied on this form will be processed and stored in manual and computerised records for recruitment, employment and management processes. You have the right to access this data. All information will be treated in the strictest confidence. Unsuccessful applicants will be retained for 3 months.

I declare that the information contained on this form is true and complete. I understand that if it is later discovered that any statement is false or misleading, it may be sufficient for cancelling any agreements made or I may be dismissed from employment by the company.

I consent to Medicare Support holding and processing this information and give permission for reference checking in connection with my application. I understand too that an Enhanced Criminal Record Bureau Disclosure will be sought.

CAPTCHA: Please verify you are a human being

1 + 4

Please enter the correct answer to the security question.

Signature *

Type your full name as your signature.

Please enter your signature.

Date *

Please enter today's date.

The information you provide will be used by Medicare Support for recruitment and application-processing purposes.