Application Form

Please complete and submit the online application form or alternatively click below to download a PDF version of the application form.

Click here to download PDF application form

Step 1 of 8

Rehabilitation of Offenders Order 1979

Do you have any convictions that are not “protected” as defined by the Rehabilitation of Offenders (Exceptions) (Northern Ireland) Order 1979, as amended in 2014? (a criminal record will not necessarily disqualify you from obtaining a position, SV Premier Care has a policy on the recruitment of ex-offenders and made available upon request)

Please write your answer

ACCESS NI ENHANCED DISCLOSURE WITH BARRED CHECKLIST

As part of your enhanced disclosure check this will include a search of the barred checklist are you on any barred checklist? *

Is there any reason why you may not be able to work in regulated activity? *

*please note it is a criminal offence to apply to work in this sector if you are listed on the barred checklist.

Working with children and vulnerable adults in ‘regulated’ activity, as defined by the Safeguarding Vulnerable Groups (NI) Order 2007, is regarded as exempt from the Rehabilitation of Offenders (NI) Order 1978.

This means all convictions must be declared and will be recorded on your disclosure certificate from Access NI – failure to disclose any cautions or convictions will result in your application being disqualified to work for SV Premier Care.

SV Premier Healthcare complies and follows the Access NI code of practice in relation to the requirements, submission, processing and handling of all candidate disclosure requests. All disclosure requests will be at the appropriate level for the role applied. A copy of the Access NI Code Of Practice which can be found –https://www.nidirect.gov.uk/publications/accessni-code-practice and made available upon request.

Access NI operates under the provisions of Part V of the Police Act 1997. All nurses and care staff will be asked to apply for an Access NI Enhanced Disclosure as part of the recruitment and selection process. Any additional information relevant after commencement of employment must correspond to SV Premier Care:

I agree to the above:

Signature

Clear Signature

Date

Please complete and submit the online application form or alternatively click below to download a PDF version of the application form.

Click here to download PDF application form

Please complete each section carefully.

Personal Details

Please complete this section if you are not a British Citizen

All Applicants

Present Health

Rehabilitation of Offenders Order 1979

ACCESS NI ENHANCED DISCLOSURE WITH BARRED CHECKLIST

NISCC Registration

Education and Training

University / Higher Education

Secondary / Further Education

Details of any other Training Courses taken

Employment History

To add new entries or delete please click on +/- within the form.

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