Please complete the below application form.
Note: As part of the recruitment process you are also required to submit the following documents:

  • Personal Identification (Passport or other official documents showing your eligibility to work in the UK)
  • Two Proof of Address [Full Driving Licence, Utility bills, Bank Statements and must be within the last three months]
  • Immunisation Details [Rubella, Hepatitis B, Varicella, Tuberculosis]
  • Educational/Training Certificates
  • Recent Passport sized Photograph x 2
  • National Insurance Number: NI Card, NI Letter or any other Official document containing your NI Number
  • P45/P46/P38
  • Curriculum Vitae
  • NMC PIN Card and Statement of Entry (Qualified Nurses Only)
  • DBS Certificate (Formerly known as CRB Disclosure)
  • Please include Proof of Covid Vaccination (NHS App or Pass from GP)

On receipt of your application, it will be processed.

Once everything comes back fine, we shall arrange an interview for you and if you are found suitable for the position applied for, the next stage is for us to organise your induction training.

As a member of staff, we can assure you of our support at all times.

Please do get in touch with us, should you have any question and we shall be glad to help.

Thank you for your interest in working for us.

Recruitment Department
Royacare Agency
247 Fore Street
N18 2TY


    Position Applied For

    Do you hold a current driving licence ?

    Do you require a work permit to be employed in the UK ?

    Emergency Contact/Next of Kin

    Employment History (Please give the full details of work history for the previous ten years, explaining any significant breaks)

    Previous Employer 1

    Previous Employer 2

    Professional References
    First Reference (Present/Most Recent Employer)

    May we approach this referee prior to interview?

    Second Reference (Present/Most Recent Employer)

    May we approach this referee prior to interview?

    Educational, Technical and Professional Qualifications
    Educational Details 1

    Was it Full Time or Part Time ?

    Educational Details 2

    Was it Full Time or Part Time ?

    Rehabilitation of Offenders Act 1974

    Have you ever been convicted of any criminal offence?

    Do you have any criminal charges pending?

    Please give the details, if the answer is ‘Yes’ to either of the above:

    N.B. Any information disclosed will be taken into consideration but will not automatically prevent the progress of your application.
    Please declare all criminal convictions, whether spent or not, charges, warnings and cautions.

    Medical Details

    Please answer the following questions by ticking the appropriate YES/NO. If the answer to any question is YES then please give details in the space provided below. It is your responsibility to inform us immediately if any of the following information changes. Have you ever had in your life, including childhood, any of the following?


    Heart/Circulation Illness/hypertension:

    Blood Disorders e.g. Anaemia, Haemophilia:

    Eye Disease/Injury or Defect:

    Asthma, Hay Fever:

    Bronchitis, Pneumonia, Pleurisy:



    Epilepsy, Frequent Fainting Attacks:

    Headaches, Migraine:

    Psychiatric Treatment:

    Dermatitis, Psoriasis, Eczema, Skin Sensitivities:

    Chicken Pox:

    Hearing Loss, Frequent Ear Infections:

    Hepatitis / Jaundice:

    Bladder Kidney Infection:

    Gynaecological Problems, Painful Periods:

    Gastric Ailments, Ulcer:

    Back Pain, Sciatica or Deformities of the spine:

    Varicose Veins:

    Do you have any deformities which affect movements?:

    Are you receiving any medication from a Doctor?:

    Have you ever been treated at hospital?:

    Are you registered Disabled Person:


    Please make sure that you read all the categories listed below and then, tick/ circle the appropriate code number:

    I am female (11)
    I am Male (12)
    I consider myself to have a disability (13)

    Note: According to the Disability Discrimination Act 1995. ‘Disability’ includes any physical or mental impairment which may have a substantial and/ or long term adverse effect on your ability to carry out some or all normal activities of the job for which you are applying.

    Please make sure you read all the categories listed below and then tick the appropriate code numbers that best describe your ethnic origin. Ethnic origin could be the origin of your role bearers, so it is not necessarily the same as nationality.

    I am white of European origin (14)

    I am white of other origin (please specify) (15)

    I am Asian
    Of Indian Origin (16)
    Of Pakistani Origin (17)
    Of Bangladeshi Origin (18)
    Of Chinese Origin (19)
    Of other origin (please specify) (20)

    I am Black
    Of Caribbean origin (21)
    Of African origin (22)
    Of other origin (please specify) (23)

    I am of another origin (please specify) (24)