Please note that you will be subject to an Enhanced DBS Check. Because you are a health care worker you are not exempt from the Rehabilitation of Offenders Act 2010. This means that all convictions, cautions, reprimands and final warnings on your criminal record must be disclosed.

Please can you provide all the addresses you have lived at in the past 5 years.

You must provide the names and contact details for at least 2 professional references who can comment on your professional abilities.

Please note that one of these must be from your current or most recent post.

Please read the following declaration carefully. Make sure that you sign and date all declarations.

Working Time Directive

Regulation of the Working Time Directive requires that a worker's average time spent at work does not exceed 48 hours within 1 rolling week unless the worker hereby agrees to exceed this limit. I hereby confirm that I am willing to opt out of the Working Time Directive. I understand that I can opt out of this agreement at any time provided I give Connect Provider Ltd one week's notice.

Please note should you choose to not opt out of the Working Time Directive that it is your responsibility to ensure that you do not work in excess of 48 hours per week.

Biba Care uses your personnel data for a number of different reasons. Personnel data is any information that identifies you or, in some cases, information that is about you such as an opinion. It includes your name, postal address, email address, date of birth, job role and bank details. We comply with the law in place in the UK around data protection when we use personal data, which is known as "GDPR"(short for General Data Protection Regulation). It allow s us to use your personal data for a number of reasons without checking with you that it's ok for us to do so. For example, where we can show that we have legitimate reasons to use your personal data or where we need to provide your personal data to care homes, hospitals or to meet a legal obligation placed on us. However, in some situations, we need you to confirm that you are happy for us to use your personal data.

We need your consent for us to carry out the following activities with your personal data.

1. Application process, references, right to work, CRB, passport, training certificates, NI number, NMC applications, health declarations and 2 current bills with home address.
2. Add your details to our database, for DBS checks, right to work, training, next of kin and phone numbers, email address.
3. Within our payroll department, your details would be used to create pay slips, email address for sending the pay slip to and phone number just incase we have to contact you.
4. For profile's we send to the homes, your training details ,DBS number, next of kin and phone number and photo ID.
5. Some of the homes will ask to see your Right to work, DBS, training certificate and photo ID.
6. Name, address and phone number would be used on the drivers listing.
7. We will not forward any of your data to a third party unless it is conjunction with your employment.

The data will be kept for as long as you are employed by Connect Provider Ltd and for 12 months after you have left the company or longer if you have a SOVA or a super vision against you. If you are unsuccessful in obtaining a position with Connect Provider Ltd, your data will be shredded within 2 weeks. If you are unsure about why we are processing your personnel data for the reasons setup above, or what we are doing with it, please ask the Data Process or on 019293 12293 who would be happy to provide more information. Please do not sign this form until you are that you understand its contents. You are giving Connect Provider Ltd consent to use your personnel data in the ways explained above. You can ask Biggs Healthcare to stop using your data in this way at anytime by speaking with Connect Provider Ltd. However if your data is removed, this would compromise your employment with Connect Provider Ltd. If you are happy for Connect Provider Ltd to use your data in the ways set out above, please sign below.