Optimal CareTech Application Form

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Step 1 of 2

Personal Details

Current Address
Click or drag a file to this area to upload.
Click or drag a file to this area to upload.

Emegency Contact Details

Emergency Contact Name
Pay Type

Working Hours



Where did you hear about us?

Additional Information

Professional References

Please enter your first referee's details
Name of Referee
Can we contact immediately
Please enter your second referee's details
Name of Referee

Declaration of Criminal Convictions

Have you ever been subject to the following
Have you ever been the subject of a conviction, caution, reprimand and warning?
Do you have any criminal proceedings pending?
Do you have an original DBS disclosure certificate?
Are you signed up to Update Service?

General Data Protection Regulation (GDPR) & Contact Consent

All personal data provided by you (the applicant) will be treated as confidential and stored / managed on our secure servers. We do however require your consent to process and transmit your information to third parties for the purpose of finding you suitable employment and obtaining essential supporting documentation. This consent covers all information we may require whilst representing you; including but not limited to your application, training & compliance, work placements, payroll and general day-to-day correspondence. Temporary work dictates the need for quick, effective communication for us to secure assignments for you. It is therefore essential for us to maintain regular contact with you across multiple channels. This includes; phone, Email, SMS and in-app push notifications (where applicable). Your consent is required for us to do so. We take data privacy and security very seriously and your personal information will be processed and secured in accordance with The General Data Protection Regulations (GDPR). Our privacy policy can be viewed on our website.

Do you give consent?


I declare that the details given by me on this application form are correct to the best of my knowledge and belief. I understand that if I have given any information which is false, or I withhold any relevant information, this may lead to my application being rejected, or if already appointed, to my dismissal. I understand that information given on this form will be processed by a computer and used for registration purposes under the Data Protection Act. I authorise XP Medical to disclose any convictions declared above to any potential employers in accordance with the DBS Code of Practice and the Rehabilitation of Offenders Act. I also accept the Terms & Conditions of Business.

Package overview
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