We offer high quality service to ensure long term relationship with our clients and customers.

Please fill out this form and be part of us!

Application Form

Part 1: Personal Details

For Qualified Nurses Only:

Next of Kin (NOK):

Part 2: Equal Opportunity

We are an Equal Opportunity Employer. The aim of our policy is to ensure that no job applicant or employee receives less favourable treatment on the grounds of race, colour, creed, nationality, ethnic or national origin, religious belief, political opinion or affiliation, sex, marital status, sexual orientation or disability, or is disadvantaged by conditions or requirements which cannot be shown to be justifiable.

Our selection criteria and procedures are frequently reviewed to ensure that individuals are selected, promoted and treated on the basis of their relevant merits and abilities.

All employees are given equal opportunity and are encouraged to progress within the organisation.

We are committed to an ongoing programmed of action to make this policy fully effective. To ensure that this policy is fully and fairly implemented and monitored, and for no other reason, would you please provide the following information.

Part 3: Qualifications & Trainings

Provide details of vocational /academic qualifications you have, most recent at first. Click Add for Multiple Qualification

Part 4: Employment History

Please write your current and previous employment history for last 10 YEARS (most recent first- Click Add for Multiple Employment)

Part 5: References

Please provide details of two referees, one being your present or most recent employer. Relatives are not allowed and should not be someone living at same address.

We need minimum of 1 Employer reference and 1 character reference, for fresh candidates, references from school/college is also accepted.

Employer Reference

Character Reference

Part 6: Disclosure & Declaration

A)  Do you have any convictions or cautions (excluding youth cautions, reprimands or warnings) that are not ‘protected’ as defined by the Ministry of Justice?

The amendments to the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975 (2013 and 2020) provides that when applying for certain jobs and activities, certain convictions and cautions are considered ‘protected’. This means that you do not need to be disclosed to employers, and if you  are disclosed, employers cannot take them into account. Guidance about whether a conviction or caution should be disclosed can be found on the Ministry of Justice website. 


I agree that AESN Limited retains the right to hold this application and any other data associated to process it and pass on to any authorized third party the details held within, also to retain the details for as long as reasonably necessary in accordance with the Data Protection Act 1998.


The European Union has laid down guidelines for all workers, governing the length of the maximum working week that is safe to work. The current limit is 48 hours per week. You are under no obligation to accept any work offered, and you will not be compelled to work more than 48 hours per week, however you may choose to do so. A full explanation of the Working Times Regulations 1998 can be found in your Staff Handbook. Please tick the appropriate box.

Part 7: Verification of Gaps in employment (if any):

do confirm that I have been out of work

Due to the following reason specified below in the box:

In order to process your application for employment with AESN Limited , please enclose :

  1. An updated copy of your CV, which should details your qualifications and any relevant training courses attended.
  2. A copy of your valid passport and any visa required for your eligibility to work in the UK .

Part 8: Payee Details

Some description about this section

Your present circumstances

Read all the following statements carefully and choose the one that Applies to you

Bank Details

I hereby declare that the information I have provided within this application is true and agree for AESN Limited to receive and hold my personal information.  I confirm that I have full authority to use the above bank/building society to receive my wages. I further confirm that I wish to opt into the scheme and agree to receive my payslips by email to the email address provided on this document.

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If you have indicated yes to any of the above questions you must provide further details, failure to do so will result in the form being returned/rejected.

Clinical diagnosis and management of tuberculosis, and measures for its prevention and control (NICE 2006)
Have you lived continuously in the UK for the last 5 years?
A cough which has lasted for more than 3 weeks
Unexplained weight loss
Have you had tuberculosis (TB) or been in recent contact with open TB
Have you ever had chicken pox or shingles
Yes No
Triple vaccination as a child (Diptheria / Tetanus / Whooping cough)
Hepatitis B (If Yes is ticked please give dates below)





Proof of Immunity (Please send the following) 

  • Varicella - You must provide a written statement to confirm that you have had chicken pox or shingles however we strongly advise that you provide serology test result showing varicella immunity

  • Tuberculosis - We require an occupational health/GP certificate of a positive scar or a record of a positive skin test result (Do not Self Declare) Rubella, Measles & Mumps Certificate of “two” MMR vaccinations or proof of a positive antibody for Rubella and Measles

  • Hepatitis B - You must provide a copy of the most recent pathology report showing titre levels of 100lu/l or above

Proof of Immunity (Please send the following) EPP Candidates Only

  • Hepatitis B Surface Antigen - Evidence of a negative Surface Antigen Test Report must be an identified validated sample. (IVS)

  • Hepatitis C - Evidence of a negative antibody test. Report must be an identified validated sample. (IVS)
  • HIV Evidence of a negative antibody test. Report must be an identified validated sample. (IVS)

Will your role involve Exposure Prone Procedures
Are you fit to work night shifts?

The purpose of this questionnaire is to ensure that you are suited to work at night. All the information you provide will be kept confidential.

Heart of Circulatory Disorders
Stomach or intestinal disorders
Any difficulties sleeping or disorders
Chronic Chest Disorders, especially night-time symptoms are troublesome
Any medical condition requiring medication to be taken to a strict time table
Any other health factors that might affect fitness at work

If you have answered “YES” to any of the questions above you may be asked to seek medical advice or to see the doctor for further assessment.

Part 9: Data Consent Form/GDPR:

hereby give my consent to the Company to process the following information:

Personal data:

  • Name
  • Date of birth
  • Contact details, including telephone number, email address and postal address
  • Experience, training and qualifications
  • CV
  • National insurance number
  • Any other relevant personal data required for job application (eg. Copy of Passport, right to work, bank statement or utility bills showing address, , reference)


Sensitive personal data

  • Disability/health condition relevant to the role
  • Criminal conviction
  • Include any other relevant sensitive personal data


I consent to the Company processing the above personal data for the following purposes:

  • For the Company to provide me with work-finding services.
  • For the Company to process with or transfer my personal data to their client/s in order to provide me with work-finding services.
  • For the Company to process my data on a computerized database system in order to provide me with work-finding services.
  • Any other relevant purposes for processing personal data:
    • DBS Application
    • Reference Request sending for character and professional
    • Training Provider/Company
    • Staff Profile (with photo ID ) to send care homes/Nursing Homes/clients
    • Suppliers’ Portal (e.g. e-tips, MORS, Appellia, Matrix, Comensura etc.)
    • Payroll – For any clients(care homes/ Nursing homes) you wished to work for

Also, I also consent to the Company processing my personal data with third parties for the purposes of internal audits and investigations carried out on the Company to ensure that the Company is complying with all relevant laws and obligations.

Part 10: Candidates Declaration

  • I confirm that the above details are complete and correct and that I am eligible to live and work in the United Kingdom. In addition, I understand that if any of the above details change, then I must contact AESN Limited to complete an alternative form.
  • I declare that I have no cautions, reprimands, final warnings, or criminal convictions other than any treated as under the provisions of Rehabilitation of Offenders Act 1974
  • I declare that I do not have any criminal history in any stage of residence for the past 5 years. I understand that it is my responsibility to declare to Human Resources / recruitment Consultants any criminal convictions incurred during my employment with AESN Limited .
  • I accept that any misinterpretation of the facts is a ground for a refusal of employment or disciplinary proceeding and or dismissal (and , in appropriate cases , criminal charges)
  • I authorize AESN Limited to approach my former employers, educational establishments, government agencies and personal referees for verification of the information
  • I consent AESN Limited to use my details for the Disclosure and Barring Service ( DBS) check, as required ,and also consent for providing an electronic result directly to the registered body that has submitted the application and that I understand an electronic result contains a message that indicates either the certificate is blank or to await certificate which will indicate that my certificate contains information. In some cases, the registered body may provide this information directly to my employer/AESN Limited  prior to me receiving my certificate. 
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