HOME
ABOUT
VACANCIES
CONTACT
SHIFT PORTAL
Menu Menu

Care, Compassion, Safety

Vacancies Header

APPLICATION FORM

Vacancies Header

APPLICATION FORM

Required Identity Documents

It is a legal requirement for all employees at Dahlia Health Care to produce valid identity documents in support of their DBS application, checks and identification. Please produce original copies of the following documents for your application to be processed.

You will need to produce three documents:

Group 1

Passport
Driving Licence (both the photo card and the counterpart licence)
Biometric Resident Permit
Birth Certificate
Adoption Certificate

Group 2

Marriage/Civil
Mortgage Statement
Bank/Building Society Statement
Credit Card Statement
Financial Statement
P45/P46 Statement
Council Tax Statement
Work Permit Visa
Utility Bill
Benefits Statements
Documents from Employment Service
Letter from Head Teacher (for those in full time education only)
Sponsorship Letter

Please fill out the below application form with information that is complete and accurate, to the best of your knowledge. We will be delighted to receive your application and will get back in touch with you as soon as possible.

"*" indicates required fields

Job Position*

Please select the job position that you are applying for:

Personal Details

Enter your personal details as they appear in your legal documents. Use a mixture of capital and lowercase letters appropriately.

Name*

Title First Last

Preferred Name*

First

National Insurance Number*

Email Address*

Preferred Phone Number*

Home Phone Number*

Mobile Phone Number*

Work Phone Number*

Home Address*

First Line Second Line City County Post Code Country

Next of Kin

Full Name*

First

Relationship*

Phone Number*

Eligibility to Work In the United Kingdom

Do you have the legal right to work in the United Kingdom (UK)?*

Yes

No

Professional Registration Number (NM)

Complete if relevant

Work Permit*

Passport Number*

Do you have a valid UK driving licence?*

Yes

No

Do you drive a car?*

Yes

No

Education & Professional Qualifications

Enter all your relevant education & professional qualifications. Indicate subjects currently being studied. Provide evidence for all the disclosed qualifications. Up to 5 qualifications can be entered here.

Qualifications*

Subject/Qualification

Place of Study

Grade/Result

Date Obtained (MM/YYYY)

Mandatory Training Courses*

Please provide evidence of all the relevant NHS mandatory training courses you have completed:

Course Title

Date Obtained (MM/YYYY)

Expiration Date

Employment History*

Provide your employment history over the past ten years. If there are any gaps in your employment, explain the reason for this in the section below.

Employer

Start Date (MM/YYYY)

End Date (MM/YYYY)

Position

Full/Part Time

Reason for Leaving

Employment Gap(s)*

State the reason(s) for any employment gaps indicated in the section above.

Referees*

Provide three referees. One of them should be your current or most recent employer.

Referee Name

Company Name

Company Address (First Line, Second Line, City, County)

Company Postal Code

Company Phone Number

Position

Personal Statement*

In the space provided, explain why you have applied for this job. Your personal statement should not be more than 2500 characters.

Equality Monitoring & Equality Act 2010

At Dahlia Health Care, we are committed to equal opportunities and we ensure that employers will not discriminate against any applicant or employee on the grounds of: marital status, age and sex/gender, race, colour, nationality, ethnicity, religion or belief, sexual orientation and disability.

Date of Birth*

DD

MM

YYYY

Gender*

Marital Status*

Ethnic Origin*

Other*

If 'Other' was selected in 'Marital Status', please provide more details:

Other*

If 'Other' was selected in 'Ethnic Origin', please provide more details:

Sexual Orientation*

Religion or Belief*

Other*

If 'Other' was selected in 'Religion or Belief', please provide more details:

Do you consider yourself to have a disability?*

Yes

No

If yes, would you like us to provide adjustments for the interview?*

Yes

No

Disclosure and Barring Service (DBS)

This application requires a declaration of any criminal convictions, either spent or unspent. An enhanced DBS check will be required, and failure to disclose your convictions will result in your application not being processed. Provide the relevant identity documents to support the DBS application.

Do you have any spent or unspent criminal convictions?*

Yes

No

Other*

If 'Yes' was selected in 'Do you have any spent or unspent criminal convictions?', please provide more details:

Record of Immunisation

At Dahlia Health Care, it is mandatory for ALL health care workers, whether they work in the private or non-private health care settings, to have an up-to-date record of their immunisations. Provide us with the required information and bring all the relevant evidence and records of your immunisation to the interview. Failure to provide the required documents will result in your application being withdrawn or not being processed.

Polio*

Date of Immunisation (DD/MM/YYYY)

Evidence of Immunisation (should be signed by a registered nurse or doctor)

File Upload*

Upload evidence of vaccination

Max. file size: 16 MB.

Tetanus*

Date of Immunisation (DD/MM/YYYY)

Evidence of Immunisation (should be signed by a registered nurse or doctor)

File Upload*

Upload evidence of vaccination

Max. file size: 16 MB.

Hepatitis B*

Date of Immunisation (DD/MM/YYYY)

Evidence of Immunisation (should be signed by a registered nurse or doctor)

File Upload*

Upload evidence of vaccination

Max. file size: 16 MB.

Rubella*

Date of Immunisation (DD/MM/YYYY)

Evidence of Immunisation (should be signed by a registered nurse or doctor)

File Upload*

Upload evidence of vaccination

Max. file size: 16 MB.

BCG (Tuberculosis)*

Date of Immunisation (DD/MM/YYYY)

Evidence of Immunisation (should be signed by a registered nurse or doctor)

File Upload*

Upload evidence of vaccination

Max. file size: 16 MB.

Varicella (Chicken Pox)*

Date of Immunisation (DD/MM/YYYY)

Evidence of Immunisation (should be signed by a registered nurse or doctor)

If you are going to work in PPE, it is essential that you provide evidence of fitness to practice.

File Upload*

Upload evidence of vaccination

Max. file size: 16 MB.

Membership of a Trade Union/Professional Organisation*

Provide evidence of membership of your trade union.

Name of Organisation

Membership

Expiry Date (DD/MM/YYYY)

Bank Details

Bank Contact Details*

Bank Address

Bank Postal Code

Bank Personal Details*

Full Name

Account Number

Sort Code (XX-XX-XX)

Statement of Declaration

I declare that the information provided in this application is correct. Dahlia Health Care reserves the right not to process your application or to terminate any employment if the information provided in this application is incorrect.

Full Name*

Signature*

Date (DD/MM/YYYY)*

Are you human? 9+7=?

LET’S GET STARTED

"*" indicates required fields

Name*

First Name Last Name

Email Address*

Message*

Are you human? 3 + 4 =*

Consent*

I agree to the privacy policy.*

Telephone Number

Mobile Number

Email Address

Office Hours

Out of Hours

01782 769427

07360 927422

info@dahliahealthcare.co.uk

9:00am to 5:00pm

365 days

Or do you want to apply? Click here >

LET’S GET STARTED

Name*
First Name Last Name
Email Address*
Message*
Consent*
I agree to the privacy policy.*
Are you human? 3 + 4 =*

Telephone Number
01782 769427

Mobile Number
07360 927422

Email Address
info@dahliahealthcare.co.uk

Office Hours
9:00am to 5:00pm

Out of Hours
365 days

Or do you want to apply?
Click here >

Footer Background (Mobile)

Terms of Use: This is a secure website and please do not share your details with anyone. By sharing your details you will be breaching the company policy of data protection and information governance. | Privacy Policy here
© Copyright Dahlia Healthcare. All rights reserved. | Website by Clyq

This site uses cookies. By continuing to browse the site, you are agreeing to our use of cookies.

Accept settings Hide notification only Settings

Cookie and Privacy Settings

How we use cookies

We may request cookies to be set on your device. We use cookies to let us know when you visit our websites, how you interact with us, to enrich your user experience, and to customize your relationship with our website.

Click on the different category headings to find out more. You can also change some of your preferences. Note that blocking some types of cookies may impact your experience on our websites and the services we are able to offer.

Essential Website Cookies

These cookies are strictly necessary to provide you with services available through our website and to use some of its features.

Because these cookies are strictly necessary to deliver the website, refusing them will have impact how our site functions. You always can block or delete cookies by changing your browser settings and force blocking all cookies on this website. But this will always prompt you to accept/refuse cookies when revisiting our site.

We fully respect if you want to refuse cookies but to avoid asking you again and again kindly allow us to store a cookie for that. You are free to opt out any time or opt in for other cookies to get a better experience. If you refuse cookies we will remove all set cookies in our domain.

We provide you with a list of stored cookies on your computer in our domain so you can check what we stored. Due to security reasons we are not able to show or modify cookies from other domains. You can check these in your browser security settings.

Check to enable permanent hiding of message bar and refuse all cookies if you do not opt in. We need 2 cookies to store this setting. Otherwise you will be prompted again when opening a new browser window or new a tab.

Click to enable/disable essential site cookies.

Other external services

We also use different external services like Google Webfonts, Google Maps, and external Video providers. Since these providers may collect personal data like your IP address we allow you to block them here. Please be aware that this might heavily reduce the functionality and appearance of our site. Changes will take effect once you reload the page.

Google Webfont Settings:

Click to enable/disable Google Webfonts.

Google Map Settings:

Click to enable/disable Google Maps.

Google reCaptcha Settings:

Click to enable/disable Google reCaptcha.

Vimeo and Youtube video embeds:

Click to enable/disable video embeds.

Accept settings Hide notification only