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Online Application Form

Personal & Professional Details
Qualifications & Employment History
References & Sickness Declaration
Areas of Practice. Skills & Training
Opt Out, Convictions & Declaration
Equal Opportunities

Welcome to our online application form. Please use this form to apply for any Knockdene HealthCare positions that you've seen advertised.

Some points to note before you get started:
• Please allow 20-25 minutes to complete your application form.
• Please complete this form in one sitting; If you're using a device other than a computer to complete your application, do not leave this page or switch tabs.
• Please have a passport photograph of yourself saved to your computer/device and ready to upload.

Personal Details

Professional Details


If you're registered with the NISCC, please enter your details below.


If you're registered with the NMC, please enter your details below.

Professional Body or Union

If you're registered with the NMC, please enter your details below.



Completing all of the fields is not required to proceed to the next step. There are separate sections for your qualifications; An 'Education' section and a "Professional/Vocational Training" section. Please fill in all of your education attainments below.











Professional/Vocational Training






Employment History

Please list all previous posts starting with your most recent or current employer. Do not leave any gaps in your employment history. If you're still employed with your most recent employer, put todays date in the "Employment To:" field.







Knockdene HealthCare requires two references, one of which must be from you current or most recent employer. A reference from a relative or colleague is not acceptable.

Reference #1

Reference #2

Absence Declarations

Please note any time lost due to absence over the last 2 years.

Period of Absence #1

Period of Absence #2

Period of Absence #3

Areas of Practice and Skills

Please tick area of practice in which you have experience and the type of skills you possess.

Section #1

Section #2

Section #3


Training Information

Please select whether you have any of the following training courses, copies of which will be required by Knockdene HealthCare.

Moving & Handling
Basic Life Support
POVA & Safeguarding Children
Infection Prevention & Control
Fire Safety
Record Keeping
Health & Safety
First Aid

48 Hour Opt Out Agreement

In this agreement the following definitions apply:

Employment Business means Knockdene HealthCare.

Working Week means an average of 48 hours in each seven day period calculated over a 17 week reference period.

Temporary Agency Worker means (your name).

Restriction means The Working Time Regulations 1998 provide that the Temporary Worker shall not work in excess of the working week unless she/he agrees in writing that this limit should not apply.

Consent means the Temporary Agency Worker hereby agrees that the working week limit shall not apply.

Withdrawal of Consent The Temporary Agency Worker shall end this agreement by giving 8 weeks’ notice in writing, however, any notice bringing this agreement to an end shall not be constructed as notice of termination, by the Temporary Agency Worker. Upon expiry of the 8 week notice period, the working week limit shall apply with immediate effect.

This Agreement is governed by the law of Northern Ireland.


Knockdene HealthCare is committed to equality of opportunity for all applicants, including those with criminal convictions. Whilst the disclosure of information does not automatically debar an individual from employment, it is essential that all convictions are disclosed to allow us to adequately consider their relevance to the post in question. Knockdene HealthCare’s policy on the recruitment of ex-offenders is available on request. Knockdene HealthCare adhere to access NI’s code of practice regarding the landing-stage and disposal of disclosure information. A copy of our policy can be obtained upon request from our office on 02825442510.

Owing to the nature of the work for which you are applying, we are required to carry out a criminal records check. Access NI are the checking body, and their code of practice is available at: This post is exempt from provisions of section 4.2 of the Rehabilitation of Offenders Act 1974 (Exemption Order 1957), and as such any criminal conviction may never be regarded as ‘spent’ and must be disclosed. Failure to disclose such convictions could result in dismissal or disciplinary action.

Any conviction, caution, reprimand will require a written statement of each and every event and how it does not affect your suitability for the role you are applying for.

Have you supplied additional information with this application for any:

Photograph Upload

Please upload a recent passport photograph:

Please note, file size must be less than 1mb and in .jpg, .png or .pdf formats.


I confirm that the information I have provided in support of this application is complete and true and understand that knowingly to make a false statement could be a criminal offence.

I consent to Knockdene HealthCare checking details I have provided in support of this application against the various data sources in order to verify my identity and process the application. These details may be recorded and used to assist other organisations, such as Access NI, NMC, Safeguarding Team, NISCC, etc.

I the undersigned, certify that the information I have provided in this application is completely true and I accept I could be prosecuted by Knockdene HealthCare Ltd. if I cause them loss, damage or embarrassment as a result of being dishonest in my dealings with them. I consent to my personal data being included on a database and to its use in order to secure me employment. I consent to my C.V. being forwarded to clients via electronic mail.

Equal Opportunities

Knockdene HealthCare is committed to being an equal opportunities employer for all applicants, irrespective of race, disability, age, gender, or religious beliefs.

We select the best suited for employment solely on the basis of merit, whilst monitoring our activities to ensure that the policy is effectively implemented as required by the Fair Employment Act 1989.

This monitoring form will be separated from your application and will also be kept separately from the information to be used in the selection process.

Any conviction, caution, reprimand will require a written statement of each and every event and how it does not affect your suitability for the role you are applying for.

Please tick the appropriate box:

Community background:

Ethnic Origin (i.e. origin by birth, not nationality)