Welcome to SEED Healthcare Services

Occupational Health Medical Questionnaire

Registration Form

1. Personal Details

2. Education/Qualifications

3.Training & Training Courses

4. Employment History

Please list out your Work Experience over the last 3 years in Healthcare, ensuring that you explain any gaps.

5. Other Experiences & Skills

Please provide a brief statement about yourself, your related experiences, skills and any other information related to you.

6. Health Questionnaire

Do you suffer from or have you ever suffered from any of the following conditions? Please select Yes or No.
I have no reason to believe that my health will interfere with my ability to undertake the duties of the assignments for which I have applied, or affect my ability to attend work on a regular basis.

To the best of my knowledge and belief, the information given above is correct. I understand that if offered assignments and the information I have provided is false, I could be liable to dismissal.

8. Referees and Next of Kin

Please provide your two most recent employers as referees. If you have not been employed please give the name of the head of education or training establishment and/or the manager of a voluntary group for whom you have worked. Please provide the latest address and telephone numbers.

Employment Reference

Please provide details of your employment referee

Employment Reference 2

Please provide details of a second employment referee

Next of Kin

9. Criminal Convictions

The nature of the work you are applying is exempt from Section 4(2) of the Rehabilitation of Offenders Act 1974 by virtue of the Rehabilitation of Offenders Act (Exceptions Order) 1975. This means that you must disclose any criminal convictions found against you., even if they might otherwise be regarded as spent. If "Yes", Please give details of the conviction(s) and date(s).

10. Finance

The Details You Provide Will Be Useful To Effect Payment For Any Work You Undertake And For Compliance Or Tax Purposes

11. New Starter Declaration

Starter Declaration

12. Working Time Directive (WTD) Declaration

This agreement is drawn up under the Working Time Directive (WTD) 1998 and enters you into an agreement with SEED Consultancy Ltd to opt out of the 48 hours limit in respect of the total weekly average hours. The Regulations state that on average you should not be asked to work more than 48 hours per week. The average is calculated over a seventeen-week period.
Click or drag files to this area to upload. You can upload up to 25 files.
Upload: (1) Right to Work- Passport Page/BRP (2) Training Certificate (3) DBS Certificates (4) Proof of Address 1 (5) Proof of Address 2 (6) Passport Photograph (7) Your CV