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PERSONAL DETAILS
First Name*
Middle Name
Last Name*
Gender
Date of Birth*
Email*
Phone*
Nationality*
National Insurance Number*
ADDRESS
Address 1*
Address 2
City*
Post Code*
REFEREE
Referee 1 Name*
Referee 1 Email*
Referee 2 Name*
Referee 2 Email*
Referee 2 Phone*
DBS INFORMATION
Do you have an existing enhanced updated DBS?* —Please choose an option—YesNo
If you have selected Yes above, please provide your DBS details below:
DBS Number
DBS Updated Service ID
Attach a copy of your DBS certificate
If you have selected No above, are you willing to undergo a full enhanced DBS Disclosure with this application for work? —Please choose an option—YesNo
PROOF OF ADDRESS
Please provide any 2 of your Driver's License, Bank Statements, or Utility Bill or Payslip issued in the last 3 months. (We accept pdf, jpg, jpeg, png, doc, docx files, with max size of 5mb)
PROOF OF RIGHT TO WORK
Do you have permission to work in the UK?* —Please choose an option—YesNo
If you have selected Yes above, please provide a proof of your right work, for example, a British Passport, Visa or Biometric Residence Permit(BRP),etc. (We accept pdf, jpg, jpeg, png, doc, docx files, with max size of 5mb)
OTHERS
Please provide your CV with Full Care Work history. (We accept pdf, jpg, jpeg, png, doc, docx files, with max size of 5mb)
Do you drive or own a car?* —Please choose an option—YesNo
Have you ever been convicted of an offence? —Please choose an option—YesNo
BANK DETAILS
Account Holder Name
Bank Sort Code
Account Number
DECLARATIONS
I am happy for Lucia Healthcare to represent me and provide my details for any Healthcare Support jobs in the UK I certify that the information on this form is to the best of my knowledge correct. I understand that any engagement entered into will be subject to satisfactory