Registration Form

Please complete this form.

All the information on the form will be treated in strict confidence and will not be divulged to any third party without written consent.

Employment History

If this is your first job please enter in the following fields: 'Name and Address of Present Employer' - FIRST JOB 'Position held' -

Previous Employers

(full employment history explaining any gaps - please use additional sheet if necessary)
If there is not enough room to type all in the cell, please continue to type as everything entered will show when the results are subitted


(Must be your line manager, we require references for your previous 5 years (must be continuous)

Referee 1

Reference 2

Reference 3

Reference 4

Ethnic Origin - Choose one section, then tick the appropriate box to indicate your cultural background

Courses attended

NVQ - Have you taken an NVQ

Additional Training / Qualifications

Right to Work in the UK

I confirm I am entitled to work in the UK on the following basis:I confirm I am entitled to work in the UK on the following basis:

Availability for work

Rehabilitation of Offenders Act 1974

By virtue of the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975, the provisions of Section 4.2 of the Rehabilitation of Offenders Act 1974 do not apply to any employment which is concerned with the provision of health services and which is of such kind as to enable the holder to have access to persons in receipt of such services in the course of his normal duties. Your answer to the following question should include any ‘spent’ convictions.

Data Protection Consent Form (GDPR)

I hereby give my consent to Better Healthcare Services to process the following information about me:
• Name
• Date of Birth
• Contact details, including telephone number, email address and postal address
• Experience, Staff Performance, training and qualifications
• CV
• National Insurance Number
• Payroll / Tax
• Bank Details
• GP Details
• Next of Kin Detail
• Passport
• Driving License
• Right to Work in the United Kingdom/ Visa
• Proof of references

Sensitive Personal Detail
• Disability/health condition relevant to the role
• DBS / Criminal conviction
• Disciplinary Information
• Religion
• Ethnic Origin Contact

• I am happy to be contacted by email, text message, phone or post

I consent to Better Healthcare processing the above personal data for the following purposes: Where I have delivered care on behalf of the company, I also consent to the Company processing my personal data with third parties for the purposes of internal audits and investigations carried out on the Company to ensure that the Company is complying with all relevant laws and obligations - this includes CQC, local authority, NHS. Managed Service Providers and clients within the care industry.
The consent I give to the Company will last for 3 years or 6 years (from the time I leave Better Healthcare) where I have worked as a carer. I am aware that I have the right to withdraw my consent at any time by informing the Company that I wish to do so.


I affirm that the information set out in this form is true and correct, is not misleading and that no material information has been omitted. I understand and agree that if I submit any false or misleading information or omit any material information this may result in an offer of employment being withdrawn or, if I have already I understand and agree that I have read the conditions of OnTrack Care Services and agree to be bound and comply with the same. I confirm that under the General Data Protection Regulation (GDPR) 2018, I hereby give my full consent to OnTrack Care Services to verify all the information given on this form and to process the information as described above under 'Data Protection Consen.

I have read and understood the Standard/ Enhanced DBS Check Privacy Policy for applicants

I agree to abide by OnTrack care Services's Polocies and Procedures

Associate Skills Profile

Care Assistant / Support Worker


Please tick the box in accordance with the level of expertise as indicated below:
1 Familiar with the procedure and can perform alone
2 Familiar with the procedure but need supervision
3 Understand the theory of the procedure but never performed the task 4 No knowledge of the procedure










EPP for Nurse applications only

If you answered yes to the above, please enter the dates for the following sections (evidence will be required at interview stage. It will need to be on letter headed paper from their doctors / hospital for traceability):
Immunisations (enter date of immunisations MM/YY)
Blood test results (enter date of blood test MM/YY)

Loan Agreement

I hereby confirm that OnTrack Care Services have provided me with a loan for the following (stated below), however OnTrack Care Services agrees to waive this loan should the aforementioned carer stay with and work for the company for a minimum of 480 hours.

Should I leave OnTrack Care Services prior to having worked a minimum of 480 hours or I do not join OnTrack Care Services having attended any part of the training, I will be responsible for reimbursing OnTrack Care Services the full cost of training as stated below.

Should the above criteria for free training not be met,OnTrack Care Services will require full payment within 30 days of the leaving date.

Please note by signing this form you are committing to attend the training course/s (subject to successful interview) - should you wish to cancel, you must do so no later than 24 hours prior to commencement of the course. Should you not cancel (in writing) within 24 hours, a cancellation fee of £50 will be applied.

Please note all training certificates are the property of Ontrack Care Services. If you wish to receive your training certificates before you have completed a minimum of 480 hours, then the cost of training must be paid.

Cost of training if not completing the agreed hours:
Induction Training £110.00
Staff uniform - Tunic £19.00
Staff uniform -Polo £15.00
On line training £22.00

Thank you for applying for work with on track care services. Your local recruiter will be in touch shortly to arrange time and date for your interview. Please allow about an hour for your interview and registration process.


To be able to complete the interview we will require you to bring documents and evidence from the below list. If you are able to upload the files, this will save time at interview

All successful applicants will be subject to a DBS (Disclosing and Baring Service) at a cost of £60 which is non refundable. However if you have a current portable DB, please bring this along as this can be accepted.