Recruitment Form

Personal Information

Name *

First

Last

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Mobile Phone *

Email *

Emergency Contact Name *

First

Last

Emergency Contact Phone *

Experience

Healthcare Level *

HCPC PIN or GMC Registration Number (if applicable)

Do you have any previous SAR experience? *

Yes
No

If yes, please provide further information

Please tell us about any other relevant qualifications that you hold e.g. ML, CERAD

Documents

Do you have a current enhanced DBS certificate including adult and children barring lists? *

Yes
No

Please upload a copy of your passport, medical and other relevant qualification certificates, ID badge photo and DBS certificate

Drag & Drop Files, Choose Files to Upload You can upload up to 10 files.

Right to work

I am a UK citizen
Non-UK citizen

Right to Work Home Office Sharecode

qualification upload children

Confirmation

I confirm I have uploaded: *

Passport photo page
Qualification certificates (or provided HCPC/GMC details)
Passport style photo for ID badge
DBS Certificate

Your Data

Peak Medical and Rescue Limited (the Company) is a data controller, and registered with the Information Commissioners Office with reference ZB748921.

The Company collects and processes certain types of data about you and does so in line with the General Data Protection Regulation and the Data Protection Act 2018.

Data will be stored for 3 years following your last contracted activity with the company, or the date of this form submission if no contracted activity is undertaken. By submitting this form, you consent to your data being processed in this way.

For further information about our data protection policy, please email info@peak-mr.co.uk.

Signature

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