Apply online

Personal Details
Area applied for*
Please state the location of the package
Name*
Prefix First Last
Mobile Phone Number*
Landline
Date of Birth*
Email*
Enter Email Confirm Email

This email will be used for all correspondence to you, unless otherwise informed.
Current Address*
Street Address Address Line 2 City ZIP / Postal Code Country
National Insurance Number - Capitals only, with no spaces*
Capitals Only, there must be no spaces
Full UK Driving License*
I confirm I have the right to remain and work in the UK*
- Yes
- No
Photo Upload (Head & Shoulders)
Accepted file types: jpg, png, pdf.
If possible please upload a photograph of yourself, similar to a passport photo, Just head and shoulders. This will be used for your ID badge if your application is successful.

Emergency Contact Details
Please provide details of your next of kin whom we could contact in an emergency.
Name*
First Last
Relationship to you*
Phone*
No spaces, e.g 07896764532
Email*

CV
If you have an updated CV - Upload it here (pdf) only
Accepted file types: pdf, docx.
*Important - Please make sure you have accounted for all gaps in the dates and reasons for leaving each employment
I can confirm that I have uploaded my CV for Libertatem Healthcare.
- Yes
- No
I am aware that as part of the recruitment process I will be required to provide my full employment history since leaving school, which will include any gaps of employment , dates and reasons for leaving each position, as this is a CQC requirement.
- Yes
- No

Education
Please select any of the following qualifications you have attained:
- NVQ Level 2 - Health & Social Care
- NVQ Level 3 - Health & Social Care
- NVQ Level 4 - Health & Social Care
- NVQ Level 5 - Health & Social Care
- Diploma in Nursing
- Degree in Nursing
- Other
If you have selected other, please list your Qualification(s) here:
Certificates
Drop files here or

Accepted file types: jpeg, gif, png, pdf.
Please upload any certificates you have received for your qualifications here

References
You will be asked to provide contact details of a minimum of 2 and a maximum of 4 people that can provide you with an employment reference, one of them must be your current and another your last employer.
Reference 1 - CURRENT/MOST RECENT employer (Include company name)*
Name*
First Last
Position*
Email*
Phone*
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Reference 2 -PREVIOUS employer (Please include company name)*
Name*
First Last
Position*
Email
Phone*
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Reference 3 - Company Name
Name
First Last
Position
Email
Phone
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Reference 4 - Company Name
Name
First Last
Position
Email
Phone
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Disclosure Barring Checks
All staff working for Libertatem Healthcare must have an up to date Enhanced DBS Certificate. If you have signed up for the transferable DBS Service you will only need to provide a small amount of information in this section. If not we will require further information from you.
Please confirm whether you are currently registered with the DBS Update Service*
This is an online service that you would have needed to register your last DBS Certificate with within 3 weeks of receiving it. You will have agreed to pay £13.00 per year to sign up to this service. If you don't remember doing this then please select "NO" in the options below.
Please provide your DBS Certificate number. This will start with 00...
This number is located on the top right-hand side of your certificate (00...) *IF NOT KNOWN AT THIS TIME, PLEASE LEAVE BLANK
Please upload an image of your current DBS Certificate page 1 and 2.
Have you had any name changes since birth?*
- Yes
- No
Please include any changes through marriage or deed poll
Please provide your previous full name*
Prefix First Last
Please provide the date on which you changed your name*
Date Format: DD slash MM slash YYYY
Have you changed your nationality since birth?*
- Yes
- No
Please provide your previous nationality*
Please provide the date on which you changed you nationality*
Date Format: DD slash MM slash YYYY
Convictions (All to complete)
Rehabilitation of Offenders Act 1974: State any convictions/offences, information of which you are not entitled to withhold, under the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975, in view of the nature of the work for which you are applying:
Do you have any convictions or offences to disclose?*
If you answer yes, you will be requested to provide details
Please provide a brief statement on this and when it was
Signature
Please leave this box blank for now, you will be asked to sign this section at interview
Have you ever been looked into by an adult or children's safeguarding service, either personally or for work?*
If you answer yes, you will be requested to provide details
Please provide a brief statement on this and when it was
Signature
Please leave this box blank for now, you will be asked to sign this section at interview

Confidentiality and Declaration
(Please do not fill in this page, this will be completed at interview)
Confidentiality
Registration implies acceptance of our code of confidentiality. In the course of your duties you may have access to confidential information about your clients. On no occasion may information relating to identifiable clients be divulged to anyone other than your branch manager or his/her assistant, without obtaining the client’s consent. You should not disclose ANY information to your family, friends or other individuals. If you are worried about any information you have obtained and consider that you should talk about it to someone else MAKE AN APPOINTMENT TO SPEAK IN PRIVATE to your MANAGER. Failure to observe these rules will be regarded as serious misconduct which could result in removal from the agency register. I have read and I understand the above and I agree to abide by the contents wherein.
Signature

Data Protection & GDPR
General Data Protection Regulation (May 2018): Libertatem Healthcare Group are registered with the Information Controllers Office and comply with all legislation relating to the use of the personal information you have supplied by registering for employment with us. You can find out more information about how we store and handle your personal data by contacting our registered head office.
The personal data that we will hold on file for you is as follows:
Your Name**** Your date of Birth**** Your Address **** Your email address**** Your telephone number**** Your NI Number**** Your next of Kin information**** Your bank details**** Your Photo**** Your Work History**** Copies of your identification**** Your DBS Certficate No ****
In order for Libertatem Healthcare Group to provide you with employment opportunities, it will be necessary for us to hold and share your personal data to either comply with employment legislation, right to work in the UK checks, comply with Care Quality Commission regulations or to facilitate payments to you via our payroll provider. Libertatem Healthcare Group will not share your personal data with any third parties other than for the purposes stated above. Please check the box above to give your consent to the company doing so:*
- I give my consent
- I do not give my consent
You have the following rights concerning your personal data: The right to be informed about the personal data we hold on file for you. The right to access the personal data we hold on file for you. The right to rectify the personal data we hold. The right to have erased the data we hold on file for you. The right to restrict the processing of data we hold for you. The right to data portability ( The right to data portability allows individuals to obtain and reuse their personal data for their own purposes across different services). The right not to be subject to automatic decision making including profiling.*
- I have read and understand my rights
Declaration
The information that I have given in this application is, to the best of my knowledge, complete and accurate in all respects, and I am not aware of any reason why I am not fit for this work. I understand that knowingly giving false information will disqualify me from registration with this agency.
Signature
Print Name
Date
Application Complete
Thank you for taking the time to fill out our online application form. Please now press the submit button below.

Libertatem Healthcare Online Application

Step 1 of 10

Personal Details

Emergency Contact Details

CV

Skills and Expertise

Education

References

Disclosure Barring Checks

Convictions (All to complete)

Identification

Confidentiality and Declaration

Confidentiality

Data Protection & GDPR

The personal data that we will hold on file for you is as follows:

Declaration

Application Complete