PERSONAL DETAILS 

* PLEASE ATTACH A LIST OF PREVIOUS ADDRESSES FOR LAST 6 YEARS – FORM ATTACHED 
Yes
No
Yes
No
We are open 24 hours a day, Please specify times at which you are not to be contacted below. 
Yes
No

CAREER HISTORY 

Please confirm your career history details for the last 10 years. Please list using most recent first. 

QUALIFICATIONS & TRAINING 

You should supply any certificates such as ENB or Diplomas etc -please note that we require manual handling/CPR certifications that have been updated in the last 12 months. 
2
3

MEDICAL HISTORY 

Have you ever suffered from any of the following: 
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Have you ever been vaccinated, immunized or tested for/against any of the Following? 
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No

REFERENCES 

Ace 24 Consultancy requires 2 professional references. It is essential that you have had professional dealings with both of your references within the last 2 years. 

OPT OUT AGREEMENT 

DEFINITIONS 
In this Agreement the following definitions apply:- 
“Assignment” means the period during which the Temporary Worker is engaged in services to a Client. 
“Client” means the person, firm or corporate body that has engaged the services of the Temporary Worker. 
“Employment Business” means Ace 24 Consultancy. 
“Temporary Worker” means a Qualified Nurse, care assistant or other Temporary Worker. 
“Working Week” means an average of 48 hours each week as calculated over any 17 week period. 
 
THE AGREEMENT 
The Working Time Regulations of 1998 state that a Temporary Worker shall not work on an Assignment with a 
client in excess of the Working Week unless they agree in writing that this limit should not apply. 
The Temporary worker, by signing the declaration below, agrees that the Working Week shall not apply to their 
Assignments. 
The Temporary Worker can end this Agreement at anytime by giving the Employment Business 14 days notice in 
writing. After the 14 day notice period has expired the Working Week shall apply immediately. 
It should be noted, that any notice ending this Agreement does not mean that a Temporary Worker has ended an 
Assignment with a Client. 
These laws are governed by English Law and are subject to the jurisdiction of the English Courts. 
 
THE DECLARATION 
I have read and fully understand the above OPT OUT AGREEMENT. 
I hereby consent that the Working Week limit shall not apply to my Assignments. 
I understand that I can end this Agreement by giving the Employment Business 14 days notice in writing. 
Yes
No

NEXT OF KIN DETAILS 

DISCLOSURES Rehabilitation of Offenders Act 

Due to the nature of the work for which you are applying, this post is exempt from the provisions of section 4.2 of the rehabilitations of offender’s act 1974 (exemption order 1975). Applicants are therefore, not entitled to withhold information about convictions which for other purposes are ‘spent’ under the provisions of the act and in the event of employment. Failure to disclose such convictions could result in dismissal or disciplinary action. 
 
Any information given will be completely confidential and will be considered only in elation to an application for positions in which the order applies, and should be entered at the end of any particulars you give in support of your application. 
 
A copy of our written policies is available upon request. A criminal record will not necessary be a bar to obtaining a position. 
 
Yes
No
Yes
No
With an enhanced disclosure, under section 4.2 of the rehabilitation of offenders act 1974 (exemption order), all previous cautions, warnings and convictions will always be detailed regardless of how long ago. 
 
Any conviction, caution, reprimand will require a written statement of each and every event and how it does not affect your suitability for the role you are applying for. 
 
Yes
No
Yes
No
IF YOU HAVE A CONVICTION/CAUTION RELATING TO A VIOLENCE OR THEFT OFFENCE, WE WILL BE UNABLE TO PROGRESS WITH YOUR APPLICATION. 
 

DECLARATION 

I confirm that the information I have provided in support of this application is complete and true and understand that knowingly to make a false statement could be a criminal offence. 
I consent to Ace 24 consultancy checking the details I have provided against the various data sources in order to verify my identity and process the application. These details may be recorded and used to assist other organisations for identity verification purposes such as the CRB, regulatory bodies such as NMC or GSCC. 
Ace 24 Consultancy retains the right to hold this application and any other data required to process this application (whether in the UK, European Union or elsewhere) and keep for as long as necessary in line with the data protection act. 

ADDITIONAL INFORMATION/CHECKLIST 

On receipt of a satisfactorily completed application form, Ace 24 Consultancy will provide/send the following:- 
1. Assist you with your DBS application for an enhanced DBS. The charge for this will be £58.39 (cheques to be made payable to Ace 24 Consultancy Ltd). 
NMC pin card and your statement of entry
Valid Passport
Valid Visa/Work Permit/Certificate of British Nationality (if applicable)
National Insurance Number Card
2 additional forms/proof of Identity & Address - (Driving Licence or copy bills etc.)
Hep B
MMR 1
MMR 2
Varicella
Hep B (IVS) HBSAg
Hep C (IVS)
HIV (IVS)
Moving and Handling (practical)
BLS / ILS / ALS
Complaints Handling
Conflict Resolution (inc management of violence &
aggression)
Fire Safety
Information Governance (including Caldicott
Protocols and Data Protection)
Health & Safety at Work (including COSHH and
RIDDOR)
Infection Control (including MRSA and C-Diff)
Lone Worker Training (if applicable)
Food Hygiene (if applicable)
IV Certificate (if applicable)
Full CV
Addresses covering the past 6 years and dates of residency
2 Passport size photos
College Details & Terms Dates (if Student)
Union Membership Details

LIMITED COMPANY BANK DETAILS OR IF PAYE PERSONAL BANK DETAILS 

WORKING TIME DIRECTIVE: WRT 48 HOURS WORKING WEEK OPT-OUT 
The Working Time Directive requires that a worker’s average working time must not exceed 48 hours per week unless the worker agrees in writing to exceed the limit. Please sign the declaration below in order that we may lawfully employ you if your hours exceed 48. Please note that by signing this Opt-Out you are not committing to a working week of more than 48 hours, but rather allowing yourself to be offered assignments that could take you over this threshold. 
TAX STATUS 
Please note l wish to be paid gross for assignments with Ace24 Consultancy. I will take account of my own income tax and national insurance contributions. If I have not provided my self assessment number it is because this is my first year of self assessment. Once the Inland Revenue 

IMPORTANT INFORMATION  PLEASE SIGN THE DECLARATION ABOVE AND SUBMIT TO CONFIRM THE ABOVE INFORMATION 

UPLOAD YOUR DOCUMENTS HERE 

We will also need details of your Bank / Building Society account for our Payroll Department. 
We try to make our registration process as swift and painless as possible but we are sure that you understand that owing to the sensitive nature of your profession that our checks have to be thorough. 
 
THANK YOU 
 
We are always looking for experienced staff to register with us. We get work all around the country so regardless of where you live, we will be able to get you some work. If you are interested in registering with us then please download our application form by clicking on the apply now button. Alternatively please enter your details below and submit your CV then one of our recruitment consultants will get in touch with you and arrange an interview. 
 

PERSONAL DETAILS 

Yes
No
Yes
No
We are open 24 hours a day, Please specify times at which you are not to be contacted below. 
Yes
No

CAREER HISTORY 

Please confirm your career history details for the last 10 years. Please list using most recent first. 

QUALIFICATIONS & TRAINING 

You should supply any certificates such as ENB or Diplomas etc -please note that we require manual handling/CPR certifications that have been updated in the last 12 months. 
2
3
4
5
6
7
8
RNLD
RHV
EN
RSCN
RFN
RM
RGN
RMN
RH
ENM
ENG
ENMH
RNMH
RECORDABLE QUALIFICATIONS 
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
MIDWIVES ONLY 
Yes
No
Yes
No

MEDICAL HISTORY 

Have you ever suffered from any of the following: 
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Have you ever been vaccinated, immunized or tested for/against any of the Following? 
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No

REFERENCES 

Ace 24 Consultancy requires 2 professional references. It is essential that you have had professional dealings with both of your references within the last 2 years. 

OPT OUT AGREEMENT 

DEFINITIONS 
In this Agreement the following definitions apply:- 
“Assignment” means the period during which the Temporary Worker is engaged in services to a Client. 
“Client” means the person, firm or corporate body that has engaged the services of the Temporary Worker. 
“Employment Business” means Ace 24 Consultancy. 
“Temporary Worker” means a Qualified Nurse, care assistant or other Temporary Worker. 
“Working Week” means an average of 48 hours each week as calculated over any 17 week period. 
 
THE AGREEMENT 
The Working Time Regulations of 1998 state that a Temporary Worker shall not work on an Assignment with a 
client in excess of the Working Week unless they agree in writing that this limit should not apply. 
The Temporary worker, by signing the declaration below, agrees that the Working Week shall not apply to their 
Assignments. 
The Temporary Worker can end this Agreement at anytime by giving the Employment Business 14 days notice in 
writing. After the 14 day notice period has expired the Working Week shall apply immediately. 
It should be noted, that any notice ending this Agreement does not mean that a Temporary Worker has ended an 
Assignment with a Client. 
These laws are governed by English Law and are subject to the jurisdiction of the English Courts. 
 
THE DECLARATION 
I have read and fully understand the above OPT OUT AGREEMENT. 
I hereby consent that the Working Week limit shall not apply to my Assignments. 
I understand that I can end this Agreement by giving the Employment Business 14 days notice in writing. 
Yes
No

NEXT OF KIN DETAILS 

DISCLOSURES Rehabilitation of Offenders Act 

Due to the nature of the work for which you are applying, this post is exempt from the provisions of section 4.2 of the rehabilitations of offender’s act 1974 (exemption order 1975). Applicants are therefore, not entitled to withhold information about convictions which for other purposes are ‘spent’ under the provisions of the act and in the event of employment. Failure to disclose such convictions could result in dismissal or disciplinary action. 
 
Any information given will be completely confidential and will be considered only in elation to an application for positions in which the order applies, and should be entered at the end of any particulars you give in support of your application. 
 
A copy of our written policies is available upon request. A criminal record will not necessary be a bar to obtaining a position. 
 
Yes
No
Yes
No
With an enhanced disclosure, under section 4.2 of the rehabilitation of offenders act 1974 (exemption order), all previous cautions, warnings and convictions will always be detailed regardless of how long ago. 
 
Any conviction, caution, reprimand will require a written statement of each and every event and how it does not affect your suitability for the role you are applying for. 
 
Yes
No
Yes
No
IF YOU HAVE A CONVICTION/CAUTION RELATING TO A VIOLENCE OR THEFT OFFENCE, WE WILL BE UNABLE TO PROGRESS WITH YOUR APPLICATION. 
 

DECLARATION 

I confirm that the information I have provided in support of this application is complete and true and understand that knowingly to make a false statement could be a criminal offence. 
I consent to Ace 24 consultancy checking the details I have provided against the various data sources in order to verify my identity and process the application. These details may be recorded and used to assist other organisations for identity verification purposes such as the CRB, regulatory bodies such as NMC or GSCC. 
Ace 24 Consultancy retains the right to hold this application and any other data required to process this application (whether in the UK, European Union or elsewhere) and keep for as long as necessary in line with the data protection act. 

ADDITIONAL INFORMATION/CHECKLIST 

On receipt of a satisfactorily completed application form, Ace 24 Consultancy will provide/send the following:- 
1. Assist you with your DBS application for an enhanced DBS. The charge for this will be £44.00 (cheques to be made payable to Ace 24 Consultancy Ltd). 
NMC pin card and your statement of entry
Valid Passport
Valid Visa/Work Permit/Certificate of British Nationality (if applicable)
National Insurance Number Card
2 additional forms/proof of Identity & Address - (Driving Licence or copy bills etc.)
Hep B
MMR 1
MMR 2
Varicella
Hep B (IVS) HBSAg
Hep C (IVS)
HIV (IVS)
Moving and Handling (practical)
BLS / ILS / ALS
Complaints Handling
Conflict Resolution (inc management of violence &
aggression)
Fire Safety
Information Governance (including Caldicott
Protocols and Data Protection)
Health & Safety at Work (including COSHH and
RIDDOR)
Infection Control (including MRSA and C-Diff)
Lone Worker Training (if applicable)
Food Hygiene (if applicable)
IV Certificate (if applicable)
Full CV
Addresses covering the past 6 years and dates of residency
2 Passport size photos
College Details & Terms Dates (if Student)
Union Membership Details

LIMITED COMPANY BANK DETAILS OR IF PAYE PERSONAL BANK DETAILS 

WORKING TIME DIRECTIVE: WRT 48 HOURS WORKING WEEK OPT-OUT 
The Working Time Directive requires that a worker’s average working time must not exceed 48 hours per week unless the worker agrees in writing to exceed the limit. Please sign the declaration below in order that we may lawfully employ you if your hours exceed 48. Please note that by signing this Opt-Out you are not committing to a working week of more than 48 hours, but rather allowing yourself to be offered assignments that could take you over this threshold. 
TAX STATUS 
Please note l wish to be paid gross for assignments with Ace24 Consultancy. I will take account of my own income tax and national insurance contributions. If I have not provided my self assessment number it is because this is my first year of self assessment. Once the Inland Revenue 

IMPORTANT INFORMATION  PLEASE SIGN THE DECLARATION ABOVE AND SUBMIT TO CONFIRM THE ABOVE INFORMATION 

UPLOAD YOUR DOCUMENTS HERE 

We will also need details of your Bank / Building Society account for our Payroll Department. 
We try to make our registration process as swift and painless as possible but we are sure that you understand that owing to the sensitive nature of your profession that our checks have to be thorough. 
 
THANK YOU 
Date
Start Time
End Time
Break
Department Name
Booking Reference No
Total Hours
Authorised By
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
For completion by the authorised ward/department signatory. 
 
I am the authorised signatory for my ward/department. I am signing below to confirm that both the band and the staff that I am authorising are accurate and I approve payment. I understand that if I knowingly authorise false information this may result in disciplinary action. 
I declare that the information I have given on this form is correct and complete and that I have not claimed elsewhere for the hours/shifts/sessions detailed on this timesheet. I understand that if I knowingly provide false information this may result in disciplinary action and I may be liable for prosecution and civil recovery proceedings. I consent to the disclosure of information from this form to the Counter Fraud and Security Management Service for the purpose of verification of this claim and the investigation, prevention, detection and prosecution of fraud. 
All timesheets must be emailed on Monday before 10:00. Incomplete timesheets will result in delayed payment. Please use separate timesheets for different clients and remember to make a copy of the timesheet for a client.