Patient Transport Jobs Application Form

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Application Information

What job would you like to apply for? *

Personal Details

Name *

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Contact Details:

Email *

Please tick preferred contact method – calls to business numbers will be made discreetly

Home
Work
Mobile

Home phone

Work phone

Mobile phone

Age *

Note you have to be over 25 to drive the EMA vehicles

General

Do you hold a current driving licence? *

Please provide your licence number? *

Is your driving licence a full / provisional / HGV / PCV licence? *

Is your driving licence free of endorsements? *

Please give details of any points or driving convictions, including any pending convictions. (Any declarations are subject to the Rehabilitation of Offenders Act 1974 (as amended).)

If the job requires it

1. Are you willing relocate? *

2. Are you willing to travel?

3. Are there any adjustments that may be required to be made should you be invited for interview?

Please give details:

Employment References

Please indicate two people who can provide professional, employment references – one of whom should preferably be your present / most recent employer.

First Reference

Name (First Reference) *

Occupation (First Reference) *

Address (First Reference) *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Phone (First Reference) *

Email (First Reference) *

Second Reference

Name (Second Reference)

Occupation (Second Reference)

Address (Second Reference)

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Phone (Second Reference)

Email (Second Reference)

Permission to take up my references prior to an offer of employment being made? *

I give permission
Do not give permission

Employment history

Please give details of all jobs held over the last 5 years including part-time and unpaid work, starting with your current or most recent employer. Please attach a copy of your CV.

Please upload your CV here (Max Size 15 MB)

Drag & Drop Files, Choose Files to Upload

Name and full address of employer; nature of business - Start Date / End Date (Reason for leaving) - Job title(s); key responsibilities / achievements - (Please list all below)

Educational, technical and professional qualifications

Please name any awarding institute or professional body in full and include attainment level specifying relevant grades or grade of membership.

School; University - Qualification ie. GCSE diploma; degree - Results; Grades - (Please list all below)

Personal development

Please include any courses, membership, voluntary work or responsibilities you have obtained that you consider relevant, with outcomes where applicable - (Please list all below)

Other skills

Languages spoken/written (please indicate level of competence)

Computer literacy (please specify software and level of competence)

Do you have armed service/public duty commitments? (eg are you a member of the TA/ a JP/ a councillor, etc.)

Please give details:

Other information

How / where did you hear about this vacancy?

Have you made an application to this company before?

Please give details:

Are you currently eligible for employment in the UK?

Please state what documentation you can provide to demonstrate this, eg British passport / European Economic Area identity card / full birth certificate / passport or travel document showing an authorisation to reside and work in the UK.

Have you ever been convicted of a criminal offence?

Please give details. (Declarations are subject to the provisions of the Rehabilitation of Offenders Act 1974 as amended.)

The Health and Social Care Act 2008

(Regulated activities)(Amendment)(Coronavirus)regulations 2021 stipulates that care home staff have the rights to refuse entry to anybody who cannot provide evidence that they have had 2 doses of an approved Covid-19 vaccination or are exempt for medical reasons. EMA Patient Transport requires you to confirm whether you have been vaccinated (applicable to Ambulance crew applicants only).

Have you had the Covid-19 vaccination?

Are you medically exempt from the Covid-19 vaccination?

Data protection statement

The information that you provide on this form and that obtained from other relevant sources will be used to process your application for employment. The personal information that you give us will also be used in a confidential manner to help us monitor our recruitment process. If you succeed in your application and take up employment with us, the information will be used in the administration of your employment with us and to provide you with information about us or a third party via your payslip. We may also use the information if there is a complaint or legal challenge relevant to this recruitment process. We may check the information collected, with third parties or with any other information held by us. We may also use or pass to third parties, information to prevent or detect crime, to protect public funds, or in other ways as permitted by law. By signing this application form we will be assuming that you agree to the processing of sensitive personal data (as described above), in accordance with our registration with the Information Commissioner.

Declaration

I declare to the best of my knowledge and belief that all particulars I have given in all parts of this application form are complete and true. I understand that any false declaration or misleading statement or a significant omission may disqualify me from employment and render me liable to dismissal. I understand that any job offer is subject to references, checks on relevant qualifications, employment eligibility and criminal convictions (if this is required for the role), a probationary period and (if the Company believes it appropriate) a medical report, all of which must be deemed by the Company as satisfactory. If you succeed in your application and take up employment with us, the information will be used in the administration of your employment with us and to provide you with information about us or a third party via your payslip. We may also use the information if there is a complaint or legal challenge relevant to this recruitment process. We may check the information collected, with third parties or with any other information held by us. We may also use or pass to third parties, information to prevent or detect crime, to protect public funds, or in other ways as permitted by law. By signing this application form we will be assuming that you agree to the processing of sensitive personal data (as described above), in accordance with our registration with the Information Commissioner.

Declaration *

I Agree

Yes please

Job Application

Application Information

Personal Details

Contact Details:

General

If the job requires it

Employment References

First Reference

Second Reference

Employment history

Educational, technical and professional qualifications

Personal development

Other skills

Other information

The Health and Social Care Act 2008

Data protection statement

Declaration