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Registration
Form
Please complete and submit this form. We will then contact you to schedule a registration interview at our office in Chessington, near Kingston, Surrey.
Please note, you will be required to provide Lime Staffing with evidence / documentation so that we can undertake the following pre-employment checks:
Identity & proof of address
Employment history & previous employer references
DBS (criminal record)
Right to work
Health / immunisation
Professional registration, training & qualifications
Your Personal Details
Title
- select -
Mr
Mrs
Miss
Ms
Other
Please select
Forename(s)
This is a required field
Known As
This is a required field
Surname
This is a required field
Address
Address Line 1
This is a required field
Address Line 2
This is a required field
Town/City
This is a required field
County
This is a required field
Postcode
This is a required field
Contact Details
Preferred Phone Number
We will use this number to call you back
This is a required field
Email Address
This is a required field
Experience
Please select your current Job Role
- select -
Registered Mental Health Nurse (RMN)
General Nurse (RGN)
Mental Health Support Worker (MHSW)
Support Worker
Health Care Assistant (HCA)
Other
Please make a selection
How long have you worked in Health/Social Care?
- select -
Less than 1 year
1-5 years
More than 5 years
Not Applicable
Please make a selection
What settings and conditions do you have experience in?
You may select multiple
PICU & Acute Hospital Units
Child & Adolescent (CAMHS) Hospital Units
Secure Forensic Hospital Units
High Dependency Hospital Units (HDUs)
Long-Term Rehabilitation Hospital Units
Brain Injury / Neuro Rehabilitation Hospital Units
Eating Disorders
Personality Disorders
Substance Misuse
Dementia
Learning / Intellectual Disabilities
Autistic Spectrum Disorders
Epilepsy and Related Disabilities
Please make a selection
Physical Disabilities
Residential Homes
Supported Living Services
Day Centres
Elderly Care & Nursing Homes
Children’s Homes
Specialist Schools / Education Facilities
Community Outreach Services
Drug & Alcohol Services
Family Support Services
Homeless Services (e.g. Shelters, Hostels)
Ex-Offender Services
Refuges (domestic violence)
Qualifications & Training
Please select the training / qualifications you have
You may select multiple
Psychology Degree
Studying Mental Health Nursing Degree
Studying General Nursing Degree
Level 2 Diploma in Health and Social Care
Level 3 Diploma in Health and Social Care
Level 4 Diploma in Health and Social Care
Level 5 Diploma in Health and Social Care
Care Certificate
Mandatory Training
PMVA
MAYBO
Immediate Life Support (ILS)
Safeguarding Level 3
Medication Management
Availability
What working hours are you seeking?
You may select multiple
Full-Time
Part-Time
Days
Nights
Weekends
What date you will be available to work from
day
01
02
03
04
05
06
07
08
09
10
11
12
13
14
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16
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19
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25
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28
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31
month
January
February
March
April
May
June
July
August
September
October
November
December
year
2018
2019
Please select
Travel
Are you a car driver with a valid licence and access to a car for work purposes?
- select -
Yes
No
Please select
Please indicate how far you are willing to travel to work
- select -
0-10 miles
11-25 miles
More than 25 miles
Please select
Upload Your CV
Optionally, Please upload your CV
Word or PDF files please
This is the valdation message
Declaration
I confirm that the information given within this form is true and accurate. I consent to it being used for personnel administration and business management purposes.
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