» Online application

Stokes Case Management Online Application Form

Step 1 of 9

I would like to apply for a position as a:*

Please select the most appropriate to your skills and experience.
Name*

First

Last
Mobile Phone Number*
Landline
Date of Birth*

Date Format: DD slash MM slash YYYY
Email*
Address*

Street Address

Address Line 2

City

ZIP / Postal Code
Current UK/EU Driving Licence*
I confirm I have the right to remain and work in the UK*
- Yes
- No
Photo Upload

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
Name*

First

Last
Relationship to you*
Phone Number*
Email

Employment History
If you have an up to date CV, then please upload it here
Last Employer*
Date employed from*

Date Format: DD slash MM slash YYYY
Date employed to

Date Format: DD slash MM slash YYYY

Leave blank if still employed
Please give a brief overview of your duties and responsibilities*

Be sure to include any clinical skills that you used and the the clinical conditions of the clients you worked with.
Previous Employer
Date employed from

Date Format: DD slash MM slash YYYY
Date employed to

Date Format: DD slash MM slash YYYY

Leave blank if still employed
Please give a brief overview of your duties and responsibilities

Be sure to include any clinical skills that you used and the the clinical conditions of the clients you worked with.
Previous Employer
Date employed from

Date Format: DD slash MM slash YYYY
Date employed to

Date Format: DD slash MM slash YYYY

Leave blank if still employed
Please give a brief overview of your duties and responsibilities

Be sure to include any clinical skills that you used and the the clinical conditions of the clients you worked with.

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", then please list your qualifications 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 most recent employer
Reference 1 – Company Name*
Name*

First

Last
Position*
Email
Phone Number*
Address

Street Address

Address Line 2

City

ZIP / Postal Code
Reference 2 – Company Name*
Name*

First

Last
Position*
Email
Phone Number*
Address

Street Address

Address Line 2

City

ZIP / Postal Code
Reference 3 – Company Name
Name

First

Last
Position
Email
Phone Number
Address

Street Address

Address Line 2

City

ZIP / Postal Code
Reference 4 – Company Name
Name

First

Last
Position
Email
Phone Number
Address

Street Address

Address Line 2

City

ZIP / Postal Code

Disclosure Barring Checks

All staff working for Stokes Case Management must have an up to date Enhanced DBS Certificate. If you have signed up for the DBS Update 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 your are 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 above..
Please provide the DBS Certificate number that your registered with the update service

The certificate number is located in the top right hand corner of the certificate
Address History

We need your address history covering the last 5 years. Please provide your addresses starting with the address before your current address. Give the month and year that you moved into each address.
Address

Street Address

Address Line 2

City

County / State / Region

ZIP / Postal Code

Country
Month and year from
Month and year to
Address

Street Address

Address Line 2

City

County / State / Region

ZIP / Postal Code

Country
Month and year from
Month and year to
Address

Street Address

Address Line 2

City

County / State / Region

ZIP / Postal Code

Country
Month and year from
Month and year to
Have you ever changed your surname since birth?
- Yes
- No
What was your previous surname?
What was the month and year that your surname changed?
Have you ever changed your nationality since birth?
- Yes
- No
What was your previous nationality?
What was the month and year that your nationality changed?
Convictions

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
If yes, then please give details

Data Protection and GDPR

General Data Protection Regulation (May 2018): Stokes Case Management 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 Stokes Case Management 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 and CSSIW regulations or to facilitate payments to you via our payroll provider and our outsourced recruitment provider. Stokes Case Management 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.
Please enter your name again by way of agreement to the declaration

First

Last

Stokes Case Management Online Application Form

Step 1 of 9

Emergency Contact Details

Employment History

Skills and Expertise

Education

References

Disclosure Barring Checks

Address History

Convictions

Identification

Data Protection and GDPR

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

Declaration