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Contact Info

Labyrinth Business Centre
43-47 Middle Hillgate,
Stockport SK1 3DG.
(0800) 772 0083
info@hillgaterecruitmentservices.co.uk

Job Vacancies

Registered Nurse

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Registered Nurse

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Registered Nurse

Requirements

Candidate name:

Role:

Thank you for enquiring about joining our agency. Please complete the enclosed forms and send them to the above address. As soon as we receive the forms we will arrange for an interview. We require copies of the following documents for registration:

Current and Valid Passport &/or Birth certificate – Issued at time

Biometric residence permit

Current driving license – photo card (Full or Provisional)

Marriage certificate (if name changed)

Proof of NI Number•

Proof of Address (X2 utility bills)

Immunisation records

Payment for DBS

X2 photo for ID

Proof of PIN if nurse

X2 Reference details

Contact details of Next of Kin

Training certificate (mandatory in-house training required)
Please select all that apply
Personal details

Employer: Hillgate Recruitment Services

PAYE reference:

Last name:

First name:

Previous name:

Date of Birth:

Gender:

Current address:

Postcode:

National Insurance Number:

Home Phone:

Mobile:

Work Phone:

Email:

Immigration Details

Are you a citizen of the EU?
Yes

No

Do you need a work permit?
Yes

No

Current driving licence?
Yes

No

Do you have a car for work use?
Yes

No

Contact Information (in case of emergency)

Name:

Relationship:

Telephone:

Mobile:

Next of Kin

Surname:

First name:

Relationship:

Mobile:

Address:

Bank Details

Name of bank:

Account no:

Account in name of:

Sort code:

Starter declaration

Tick one of the following three statements:
This is my first job since last 6 April and I have not been receiving taxable Jobseeker's Allowance, Employment and Support Allowance, taxable Incapacity Benefit, State or Occupational Pension.

This is now my only job but since last 6 April I have had another job, or received taxable Jobseeker's Allowance, Employment and Support Allowance, taxable Incapacity Benefit. I do not receive a State or Occupational Pension.

As well as my new job, I have another job or receive a State or Occupational Pension.

Student Loans I make:
Type 1 Student Loan repayments through payroll

Type 2 Student Loan repayments through payroll

PostGrad Loan repayments through payroll

Not Applicable

Name as Signature(Declaration):

Employment Start Date:
Previous Employment

A full employment history must be detailed beginning with your current employment, and covering all reasons for gaps in any given year.

From:

To:

Employer’s name:

Position held:

Salary:

Reason for leaving:

From:

To:

Employer’s name:

Position held:

Salary:

Reason for leaving:

From:

To:

Employer’s name:

Position held:

Salary:

Reason for leaving:

From:

To:

Employer’s name:

Position held:

Salary:

Reason for leaving:

From:

To:

Employer’s name:

Position held:

Salary:

Reason for leaving:
Education and Professional Qualifications

(Original documents as proof of qualification will be required at interview)

Secondary School / College / University:

Examinations taken:

Result:

Secondary School / College / University:

Examinations taken:

Result:

Secondary School / College / University:

Examinations taken:

Result:

Secondary School / College / University:

Examinations taken:

Result:

Secondary School / College / University:

Examinations taken:

Result:
Rehabilitation of Offenders Act 1974 – Notice To Offenders

Because of the nature of the work involved, the post for which you are applying is exempt from Section 4(2) of the Rehabilitation of Offenders Act 1974 by virtue of the Rehabilitation Offenders Act (Exemption Order 1975). This means that you are not entitled to withhold information relating to any convictions you may have had.

Do you have any convictions to disclose?
Yes

No

Any information should be given on a separate sheet and sent with this application form. This information will be treated as confidential and will not necessarily preclude you from employment.

Name as Signature:
Additional Personal Details

Outside interests, leisure time activities and other personal information which you think may assist us in evaluating your application.

More about me:
References

Please give the name and address of two referees, one of whom must be your present employer, or your previous employer.

Name:

Status:

Address and Telephone No:

Name:

Status:

Address and Telephone No:

Name:

Status:

Address and Telephone No:

This organisation seeks to work in a flexible and family friendly manner with its staff, however unsocial hours are part and parcel of a quality care service. Weekend working is a requirement for all staff, the frequency of which will be determined

Please indicate holiday dates if already booked:

Period of notice required in present post:

Earliest start date:

Thank you for completing this application form. I declare that to the best of my knowledge, all of the information contained and documented herein is complete and truthful.

Name as Signature:
Equal Opportunities Monitoring

This section of the application will be detached and used for monitoring purposes only. Our organisation recognise and actively promote the benefits of a workforce and are committed to treating all employees with dignity and respect regardless of race, gender, disability, age, sexual orientation religion or belief. We welcome applications from all sections of the community.

Date of birth:

Gender:

Race Relations (Amendment) 2000

Bangladeshi

Indian

Pakistani

Any other Asian background

African

Caribbean

Any other Black background

White & Asian

White & Black African

White & Black Caribbean

Any other missed background

British

Irish

Any other white background

Chinese

Any other ethnic group

I do not want to disclose this

Employment Equality Regulations 2003

Please indicate what describes your sexuality.
Lesbian

Gay

Bisexual

Heterosexual

I do not wish to disclose

Please indicate your religion.
Atheism

Buddhism

Christianity

Islam

Jainism

Sikhism

Judaism

Hinduism

Other

I do not wish to disclose this
Health Questionnaire

In order to comply with the Health and Social Care Act 2008 and the Equality Act 2010, please complete this questionnaire as fully as possible. Failure to do so could impede or delay your appointment. All information is confidential.

Have you ever had or suffered from:

Epilepsy/Blackouts
Yes

No

Nervous Mental Disorders
Yes

No

Migraine/Headaches
Yes

No

Sensory Impairment
Yes

No

Skin Allergies
Yes

No

Back pain/Previous Back Injury
Yes

No

Heart Condition
Yes

No

Asthmatic or respiratory ailments
Yes

No

Recurring Incidence of Illness
Yes

No

Are you registered disabled?
Yes

No

If yes, please detail:

Please List Below any Periods spent Outside of the United Kingdom as a Resident (do not include holidays):

Please List below any vaccinations or immunisations.

Vaccinations

Date Immunisation Expiry

Vaccinations

Date Immunisation Expiry

Vaccinations

Date Immunisation Expiry

Vaccinations

Date Immunisation Expiry

I declare that the information given is correct to the best of my knowledge. in my view, i am fit physically and mentally to undertake this post. I understand that omissions or false statements may disqualify me from employment or lead to dismissal. I give the employer the right to investigate all references.

Name as Signature:
DBS Consent Form
This new subscription service lets individuals keep their DBS certificate up-to-date so you can take it with you when you move jobs or roles.

As a Registered Body, Hillgate Recruitment Services can then carry out online, instant checks to see if any new information has come to light since the certificate’s issue - this is called a status check.

The DBS update service check will allow you to have greater control of your own information and allow DBS certificates to be reused when applying for similar jobs. You will also be able to see who has carried out a status check, and when they did, from your online account.

What should you do now?
- Subscribe to the update service. An annual fee of £13.00 will be payable to the DBS. You can subscribe 28 days of DBS receiving your application or 14 days after the issue date of the Certificate.
  
  By signing below, you give ongoing consent to:
- VCare staffing Solution Limited to carryout a Status check (DBS and Regulated Activity) on you each time it is necessary,in accordance with the DFE and DBS guidelines.
  
  Should you wish for the consent to be withdrawn, please provide Hillgate Recruitment services with written notice confirming your withdrawal.
Name as Signature:

Skills Checklist – Carer

Please Tick the Box in accordance w the level of expertise as indicated below:
1. Familiar with procedure and can perform alone
2. Familiar with procedure but needs supervision
3. Understand theory of the procedure but never performed task
4. No knowledge of the procedure

Speciality

Grade:

Personal Hygiene	1	2	3	4
Bath/Shower/Assisted wash
Use of Bath aids
Mouth Care (Including Dentures)
Care of feet (Exluding toe nails)
Dressing/Undressing of patients
Bed Bath
Shaving
Care of hair
Care of Finger nails
Care of eyes
Pressure area care

Toileting	1	2	3	4
Emptying and changing a catheter bag
Catheter care
Stoma care
Use of bedpans/urine bottles/commodes
Collection of stool/urine/sputum
Incontinence care

Mobility	1	2	3	4
Moving and Handling
Use of Hoists
Use of Walking aids
Use of Wheel Chair

Nutrition	1	2	3	4
Preparation of food
Special diets
Supervision with eating
Assistance with feeding

Infection Control	1	2	3	4
Caring for MRSA positive patients
Barrier nursing
Isolation
Universal precautions
Hand washing
Cross Infection

Observations	1	2	3	4
Observing Patients Confidentiality
Taking temperatures
Checking Blood Pressure
TPR/BP recording chart
Checking pulse/Respiration
Blood sugar Testing
Urine Testing
Observing/recording changes in patient
condition and reporting to senior sta

General	1	2	3	4
First Aid
Awareness of Health & Safety Precautions
Bed Making
Simple Dressing
Report writing handover
Laundry
Shopping
Domestic Duties

Knowledge of Service User Groups	1	2	3	4
Elderly people
Dementia
Palliative care/ care of terminally ill
People with Physical disabilities
People with mental health problems
People living with HIV/AIDS
Children/families

Working Time Regulations Form & Student Declaration

If you choose not to sign this document, you are restricting your hours available to work to no more than 48 hours in any one week period.

If you choose to sign this declaration, Hillgate recruitment Services will not hold you to working more than 48 hours per week. It is your choice and at you personal discretion if you choose to work more or less than 48 hours.

I agree that I may work for more than an average of 48 hours per week.

If I choose to change this agreement, I will give Hillgate recruitment Services one months notice in writing to end this agreement.
Student declaration form

Strictly confidential
UK Students: Please complete sections A, C and D
Overseas Students: Please complete sections A, B and D

Section A: All students
I am a UK/Overseas (delete as appropriate) Student currently studying

Course

At: College/University

Section B: Overseas students

My permit allows me to work no more than ________ hours a week.

Section C: UK students

I am allowed to work no more than _______ hours a week

I am allowed to work outside term time only

I have no restrictions on my working hours/times

Section D: All students

Declaration: I confirm that the information I have provided is correct. Any misleading or inaccu- rate information given may result in Hillgate recruitment Services terminating my employment.
Health Questionnaire – Non Clinical Staff

CONFIDENTIAL
The purpose of the questionnaire is to see whether you have any health problems that could affect your ability to undertake the duties of the post you have been offered or place you at any risk in the workplace. We may recommend adjustments or assistance as a result of this assessment to enable you to do the job. Our aim is to promote and maintain the health of all people at work. Before health clearance is given for employment you may be contacted by our nominated occupational health service provider and may need to be seen by an occupational health advisor or physician. Your record will be held on file for a short period of time and may be subject to audit.

Personal Information

Title

Surname

First name

Date of Birth

Home Tel

Work Tel

Mobile

Home address:

GP address:

All staff groups complete this section

Do you have any illness/impairment/disability (physical or psychological) which may affect your work?
Yes

No

Have you ever had any illness/impairment/disability which may have been caused or made worse by your work?
Yes

No

Are you having, or waiting for treatment (including medication) or investigations at present? If your answer is yes, please provide further details of the condition, treatment and dates
Yes

No

Do you think you may need any adjustments or assistance to help you to do the job?
Yes

No

*If you have indicated yes to any of the above questions you must provide further details, failure to do so will result in the form being returned/rejected.

Tuberculosis
Clinical diagnosis and management of tuberculosis, and measures for its prevention and control (NICE 2006)

Have you lived continuously in the UK for the last 5 years?
Yes

No
If you answered NO to the above, please list all of the countries that you have lived in/visited over the last 5 years, including duration of stay and dates i.e. United Kingdom July 2012 to November 2012.

Have you had a BCG vaccination in relation to Tuberculosis?
Yes

No
If you answered yes please state when

Do you have any of the following

A cough which has lasted for more than 3 weeks
Yes

No

Unexplained weight loss
Yes

No

Unexplained fever
Yes

No

Have you had tuberculosis (TB) or been in recent contact with open TB
Yes

No

Additional Information
(If you have answered yes to any questions please provide further details below)

Recommendations
I understand that if any recommendations to my employer are necessary as a result of this Assessment.

I give consent for the nominated occupational health service provider to make recommendations to my employer, without me having seen a written copy of the recommendation first

I would like to see a written copy of any recommendations the Health and Work Centre may make to my employer before they are sent to my employer.

Declaration

I declare that the answers to the above questions are true and complete to the best of my knowledge.
Bank Payment Details Form

Authorisation For Payment Directly Into Your Bank Account - Please Write Clearly As Any Errors May Result In Payment Being Sent To Wrong Account

Title:

Name

Address:

Post code

National Insurance Number

Phone Number

Email

Paye or Contractor

Bank Details

Name of Bank/Building Society

Bank / Building Society Address

Branch Name

Account Name

Sort Code

Account Number
Staff Consent

This consent is to protect staff information which is currently held under the Data Protection Act 2018 and the Freedom of Information Act 2000.

a) I understand that as part of the contractual arrangements between Hillgate Recruitment services Limited and the Local Authority contracts team, that the monitoring of the contract gives access to my personal file during their monitoring visits.

Name as Signature

b) I understand that the Care Quality Commission has the right to access my file as part of the compliance review process.

Name as Signature

c) The EU Working Time Directive allows workers to “opt out” of working a maximum of 48 hours in any week. Please indicate your choice.
I wish to work a maximum of 48 hours in any week

Or

I wish to “opt out” of the working time directive and be able to work more hours should I wish to do so.

If I wish to change these arrangements I understand that I must give 4 weeks’ notice in writing of any changes.

Within the current legislative framework, the Care Quality Commission has a right to view all and any forms, correspondence, paperwork which is kept and held under the Data Protection Act 2018 and the freedom of Information Act 2000 within the offices of Hillgate Recruitment Services Limited. Within the service specification of the contract with the Local Authority, the same right is conferred to the monitoring function.
Payment Deduction Authorisation

I authorise Hillgate Recruitment Services Limited to deduct the sum of (Pounds) as payment towards Hospital Training/Manual Training

/CPR Training / CRB Processing / Staff Advance before giving me my salary / wages

Name as Signature
Photo Verification

PLEASE ATTACH 2X PASSPORT PHOTOS HERE OR IF YOU ARE SENDING THEM ELECTRONICALLY JUST COMPLETE THE SECTION BELOW.

Add Photo (.png or .jpg)

Please sign to verify that the photographs copied above are a true copy of the ones that you have brought with you today.

Name as Signature
Casual Worker Agreement
Following our recent meeting I am delighted to be able to offer you casual work with the Company under the following terms and conditions.
1. 1. Status of this Agreement
  This contract governs your engagement from time to time by Hillgate Recruitment Services as a Casual Worker. This is not an employment contract and does not confer any employment rights on you (other than those to which workers are entitled). In particular, it does not create any obligation on you to perform work for the Company (even if offered) or on the Company to provide work to you and therefore there will be no mutuality of obligation between the Company and you.
2. 2. Company’s discretion as to work offered
  It is entirely at the discretion of the Company whether to offer you work and it is under no obligation to provide work to you at any time. The Company reserves the right to give or not give work to any person at any time and is under no obligation to give reasons for such decisions.
3. 3. No presumption of continuity
  Each offer of work by the Company which you accept shall be treated as an entirely separate and severable engagement (an assignment). The terms of the contract shall apply to each assignment but there shall be no relationship between the parties after the end of one assignment and before the start of any subsequent assignment. The fact that the Company has offered you work, or offers you work more than once, shall not confer any legal rights on you and, in particular, should not be regarded as establishing an entitlement to regular work or conferring continuity of employment.
4. 4. Arrangements for work
  If the Company wants to offer you any work it will call, text or email you the details of the assignment. You are under no obligation to accept any work offered by the Company at any time. However, if you accept an assignment you must inform the Company immediately if you will be unable to complete it for any reason.
  The Company reserves the right to terminate an assignment at any time for operational reasons. You will be paid for all work done during an assignment up to the time it is terminated. In order to assist the Company in organising work, please complete the personal information sheet attached to this contract and return it to manager by _____________. It is your responsibility to inform the Company of any changes to these details.
5. 5. Work
  The Company may offer you work from time to time as Health Care Assistant/Support worker. If you accept work your duties will include providing care to service users and you will usually report to manager. The precise description and nature of your work may be varied with each assignment and you may be required to carry out other duties as necessary to meet business needs. You will be informed of the requirements at the start of each assignment.
  Before offering you an assignment the Company will require certain documents from you in order to satisfy itself that you are legally entitled to work in the UK.
  You confirm that you are legally entitled to work without any additional immigration approvals and agree to notify the Company immediately if you cease to be so entitled at any time.
6. 6. Place of work
  During each assignment your place of work will be Preston OR the Company may offer you work at various locations. You will be informed of the relevant place of work for each assignment.
7. 7. Hours of work
  During each assignment your hours of work will vary depending on the operational requirements of the Company. You will be informed of the required hours for each assignment.
  You will be entitled to an unpaid break of (one hour) where your assignment requires you to work more than (six hours) in any one day.
  Company timesheets recording the actual hours worked are to be completed and submitted to the office on a weekly basis.
8. 8. Working Time Opt-Out
  Please complete the attached from to confirm whether you wish to put out of the 48 hour limit on a week’s work. If you do not opt out, the Company must ensure that it does not offer you work which would result in you working for more than 48 hours in any week. You must then keep the Company informed of the hours that you work for third parties so that it can comply with this obligation.
9. 9. Pay
  You will be paid for the hours that you work. The Company’s current rate of pay for casual workers is £ ______________ an hour gross. You will be paid weekly/monthly in arrears on or about the last day of each month, directly into your bank account for the hours worked in the previous month. The Company will make all necessary deductions from your pay as required by law and shall be entitled to deduct from your pay or other payments due to you any money which you may owe to the Company at any time.
10. 10. Holidays
  Your holiday entitlement will depend on the number of hours that you actually work and be pro-rated on the basis of a full time entitlement of 28 days holiday during each full holiday year. This entitlement includes the usual 8 public holidays in England and Wales. The Company’s holiday year runs from (01/01) to (21/12).
  At the end of each assignment the Company will pay you in lieu of any accrued but untaken holiday for the holiday year in which the assignment ends. The amount of the payment in lieu will be calculated by taking 12.07% of the hours worked during the assignment and multiplying this by your hourly rate of pay. (See paragraph 9 above).
  For operational reasons you will not normally be entitled to take leave during an assignment, but permission may be granted in exceptional circumstances.
  If you have taken and been paid for more holiday than your accrued entitlement at the date your assignment ends, the Company shall be entitled to deduct from you any overpayment which has been made.
11. 11. Sickness
  If you have accepted an offer of work but are subsequently unable to work the hours agreed, you must notify the manager of the reason for your absence as soon as possible but no later than (time) on the first day of absence
  You will not be entitled to receive any pay in respect of any period of sickness or injury during an assignment. As you are not an employee you have no entitlement to Statutory Sick Pay.
12. 12. Data Protection
  You consent to us holding and processing, both electronically and manually, the data that we collect about you, in the course of your working relationship with us, for the purposes of administration and management of our staff and our business and for compliance with applicable laws, procedures and regulations.
13. 13. Company rules and procedures
  During each assignment you are required at all times to comply with relevant Company rules, policies and procedures in force from time to time including but not limited to those contained in the staff handbook, a copy of which has been given to you OR which is available from the staff portal of the website.
14. 14. Confidential Information
  You shall not use or disclose to any person, either during or at any time after your engagement by the Company, any confidential information about the business or affairs of the Company (or any of its business contacts) or about any other matters which may come to your knowledge as a result of carrying out assignments. For the purposes of this clause confidential information means any information which is not in the public domain and which relates to the affairs of the Company (or any of its business contacts).
  The restriction in this clause does not apply to:
  a) Prevent you from making a protected disclosure within the meaning of section 43A of the Employment Rights Act 1996; or
  b) Use or disclosure that has been authorised by the Company or is required by law or in the course of your duties.
15. 15. Company property
  All documents, manuals, hardware and software provided for your use by the Company, and any data or documents (including copies) produced, maintained or stored on the Company’s computer systems or other electronic equipment (including mobile phones) remain the property of the Company.
  Any Company property in your possession and any original or copy documents obtained by you in the course of your work for the Company shall be returned to the manager at any time on request and in any event at the end of the assignment.
16. 16. Termination
  If you wish your name to be removed from the Company’s staff bank or no longer wish to be considered for casual work by the Company you should inform the manager as soon as possible.
  The Company may remove your name from its staff bank if you are unable to accept an assignment on (three) occasions OR work for (four) consecutive weeks.
  The Company may terminate this contract immediately by giving notice in writing to you if it reasonably considers that you have committed any serious breach of its terms or committed any act of gross misconduct. Non-exhaustive examples of gross misconduct include (dishonest, theft, fighting, mis-use of drugs or alcohol or any acts or omission which) might bring the Company into disrepute).
17. 17. Changing Terms and conditions
  The Company may review its requirement for casual workers from time to time and/or may update the terms on which it offers such work. In the event of any changes to the terms on which it is prepared to engage casual workers the Company may terminate this contract with immediate effect by giving notice to you and you may, at the Company’s absolute discretion, be offered a new contract for casual work.
18. 18. Governing law
  This contract will be governed by English law. If you wish to accept casual work from the Company on the terms stated above you are requested to sign and date one copy of this agreement and return it to manager as soon as possible. We look forward very much to you joining the team and trust that we shall have an enjoyable and satisfying relationship.
Position:

Name as Signature:
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Job Vacancies

Registered Nurse

Requirements

Personal details

Contact Information (in case of emergency)

Next of Kin

Bank Details

Starter declaration

Previous Employment

Education and Professional Qualifications

Rehabilitation of Offenders Act 1974 – Notice To Offenders

Additional Personal Details

References

Equal Opportunities Monitoring

Race Relations (Amendment) 2000

Employment Equality Regulations 2003

Health Questionnaire

Have you ever had or suffered from:

DBS Consent Form

Skills Checklist – Carer

Working Time Regulations Form & Student Declaration

Student declaration form

Section A: All students

Section B: Overseas students

Section C: UK students

Section D: All students

Health Questionnaire – Non Clinical Staff

Personal Information

All staff groups complete this section

Tuberculosis

Additional Information

Recommendations

Declaration

Bank Payment Details Form

Bank Details

Staff Consent

Payment Deduction Authorisation

Photo Verification

Casual Worker Agreement

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