Author:
admin
New Starter Application Form
Personal Information
Position Applied For
Select
First Aider (1) EFAW or Equivalent
First Aider (2) FAW or Equivalent
First Responder (3) FREC3 or Equivalent
First Responder (4) FREC4 or Equivalent
Emergency Care Assistant NHS Trust ECA
Ambulance Technician IHCD FRECU5 AAP
Paramedic HCPC Registered
Specialist/Advanced Paramedic HCPC Registered
Nurse NMC Registered
Nurse Practitioner NMC Registered
Doctor GMC Registered
Event 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
*
Country
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China, People’s Republic of
Christmas Island
Cocos Islands
Colombia
Comoros
Congo, Democratic Republic of the
Congo, Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Côte d’Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
East Timor
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
France, Metropolitan
French Guiana
French Polynesia
French South Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island And Mcdonald Island
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Johnston Island
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic People’s Republic of
Korea, Republic of
Kosovo
Kuwait
Kyrgyzstan
Lao People’s Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Macedonia
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Reunion Island
Romania
Russia
Rwanda
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Pierre & Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and South Sandwich
Spain
Sri Lanka
Stateless Persons
Sudan
Sudan, South
Suriname
Svalbard and Jan Mayen
Swaziland
Sweden
Switzerland
Syria
Taiwan, Republic of China
Tajikistan
Tanzania
Thailand
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks And Caicos Islands
Tuvalu
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States of America (USA)
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Virgin Islands, British
Virgin Islands, U.S.
Wallis And Futuna Islands
Western Sahara
Yemen
Zambia
Zimbabwe
HCPC / NMC / GMC Registration Number If Registered
DBS Certificate
Have you had a DBS within the last 3 years?
*
Yes
No
Enter DBS Certificate Number
Enter The Date DBS Check Was Done
Are Subscribed to the DBS Update Service?
*
Yes
No
Do you give us permission to check your DBS on the update service?
Yes
No
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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No file chosen
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Driving
Do you hold a full driving UK license?
*
Yes
No
Please enter your Driving License Number
Do you have a C1 entitlement ?
*
Yes
No
Do you have a blue light qualification?
*
Yes
No
Upload A Copy Of Your Blue Light Certificate
Choose File
No file chosen
Delete 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.
*
PAYE
Subcontractor
More 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