• New Starter Application Form

  
  

  Personal Information

  Position Applied ForSelectFirst Aider (1) EFAW or EquivalentFirst Aider (2) FAW or EquivalentFirst Responder (3) FREC3 or EquivalentFirst Responder (4) FREC4 or EquivalentEmergency Care Assistant NHS Trust ECAAmbulance Technician IHCD FRECU5 AAPParamedic HCPC RegisteredSpecialist/Advanced Paramedic HCPC RegisteredNurse NMC RegisteredNurse Practitioner NMC RegisteredDoctor GMC RegisteredEvent Support Team (Non-Clinical Role)Logistics Team (Non-Clinical Role)Control Room Team

  Name *

  Date Of Birth *

  Email Address *

  Phone *

  Address Line 1 *

  Address Line 2

  City *

  County *

  Post Code *

  CountryAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBruneiBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChina, People’s Republic ofChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d’IvoireDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrance, MetropolitanFrench GuianaFrench PolynesiaFrench South TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island And Mcdonald IslandHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJerseyJohnston IslandJordanKazakhstanKenyaKiribatiKorea, Democratic People’s Republic ofKorea, Republic ofKosovoKuwaitKyrgyzstanLao People’s Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarReunion IslandRomaniaRussiaRwandaSaint HelenaSaint Kitts and NevisSaint LuciaSaint Pierre & MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and South SandwichSpainSri LankaStateless PersonsSudanSudan, SouthSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwan, Republic of ChinaTajikistanTanzaniaThailandTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks And Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited States of America (USA)UruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis And Futuna IslandsWestern SaharaYemenZambiaZimbabwe

  HCPC / NMC / GMC Registration Number If Registered

  DBS Certificate

  Have you had a DBS within the last 3 years? *YesNo

  Enter DBS Certificate Number

  Enter The Date DBS Check Was Done

  Are Subscribed to the DBS Update Service? *YesNo

  Do you give us permission to check your DBS on the update service?YesNo

  Please upload a picture of your certificate

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  Background

  Education

  Qualification Title *

  Date Achieved *

  Institution Name

  Upload Certificate

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  Work Experience

  Company Name

  Employment Period Start Date

  Employment End Date (leave blank if current)

  Job Responsibilities

  Please Add Any Further Relevant Experience .

  CV Upload if you have one.

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  Driving

  Do you hold a full driving UK license? *YesNo

  Please enter your Driving License Number

  Do you have a C1 entitlement ? *YesNo

  Do you have a blue light qualification? *YesNo

  Upload A Copy Of Your Blue Light Certificate

  Choose FileNo file chosenDelete uploaded file

  Personal Statement

  Please give a personal statement below, detailing how you feel you are suitable for the role applied for. Please include any relevant previous experience and aspirations for the future.

  References Please Give Details of 2 Referees ( One Referee Should be your current or most recent employer)

  Referee Name *

  Employer *

  Contact Details (Telephone Number or Email Address) *

  Employment Options

  We offer the option to join our PAYE system where we organise your Tax and National insurance payments for you. . Or you can work as a self employed subcontractor (certain requirements will need to be met ) please select which option you would prefer, or request further information explaining the differences. *PAYESubcontractorMore details required

  Consent *

  • I confirm that the information contained within this form is as accurate as possible. If any of this information changes, I will undertake to inform the management team at Astrix Waterside Medical at the earliest opportunity.
  • I understand that failure to complete this form in a truthful and accurate manner may lead to my application being denied and/or immediate disciplinary proceedings or dismissal from the company.
  • I Give Permission for Astrix Waterside Medical to obtain references prior to interview based on the information contained within this form
  • I give my permission for Astrix Waterside Medical to add me to the shift availability and staff announcement WhatsApp groups.

  Apply

  November 5, 2025