Join Our Team

Prime Time Care and Support Services is looking for dedicated, compassionate professionals to join our community. Please complete the form below to apply.

Employment Application Form

1. Personal Information

Title (Mr / Mrs / Ms / Dr / Other)

First / Middle name(s)

Surname

Date of birth (DD/MM/YYYY)

National Insurance number

DBS certificate number

Home phone

Mobile phone

Email address

Address

Postcode

Notes (office use only)

2. Passport / Visa Details

Passport nationality

Passport expiry date

Type of visa / work permit held

Visa / work permit expiry date

Visa restrictions (if applicable)

3. Position Applied For

Select all roles that apply.

Care WorkerSupport WorkerQualified NurseHealthcare AssistantMidwife / Health VisitorSocial WorkerRadiographer / SonographerNon-Medical / Non-ClinicalOther (specify below)

If “Other”, please specify

4. Qualifications

List all relevant qualifications (institution, dates, qualification).

5. Employment History

Most recent employer

From (MM/YY)

To (MM/YY)

Employer name & address

Job title & specialities

Reason for leaving

Previous employer 2

From (MM/YY)

To (MM/YY)

Employer name & address

Job title & specialities

Reason for leaving

Previous employer 3

From (MM/YY)

To (MM/YY)

Employer name & address

Job title & specialities

Reason for leaving

6. Professional References

Referee 1

Referee name

Position held

Business address

Postcode

Telephone

Referee 2

Referee name

Position held

Business address

Postcode

Telephone

7. Emergency Contact / Next of Kin

First name

Surname

Address

Postcode

Tel no.

Mobile no.

Relationship to you

8. Confidentiality Agreement

I understand that any information regarding patients or clients is confidential and must not be disclosed outside Prime Time Care and Support Services.

9. DBS & Offences

Any unprotected convictions? YesNo

If yes, details

DBS issued in last 12 months? YesNo

DBS number

Issue date

DBS Update Service? YesNo

10. References Consent

I give permission for Prime Time Care and Support Services to obtain references covering the last 3 years.

11. Declaration

I declare that the information provided is accurate to the best of my knowledge.

Name

Date