Healthcare ltd

PHOTO

REGISTRATION FORM
Registration Date Reference No

1. Personal Details
Mr.
Title (Mr/Mrs/Miss/Ms) D.O.B 30/12/1990

John Kanwai Francis

First Name Middle Name Last Name

Maiden or Previous Name (If Applicable)

Ade Support Worker

Home hi Work
Address
Flat 4, Behind +2348069221918
Celestial Fax Mobile
Church
9611 fra
Post Code 03 Email nci
sco
joh
n22
0@
gm
ail.
co
m
Skype ID

NI No. Preferred Method Of Contact Email and

Phone call
Nigeria
Nationality
Support Speciality Care
Job Title Worker/Health give
 care Assistant r
No
Do you hold a driving license?
2. Professional Memberships

NMC Pin No Expiry Date

Careskill Academy Certificate
RCN MDU Other (Please Specify)

Membership No Expiry Date

3. Qualification / Training
Qualification Grade Date Taken

Adult General Nursing

Children's Nursing

Learning Disability Nursing

Mental Health Nursing

Midwifery

Training Courses Attended Date Taken

Transcript Obtained Attached

Firs Aid, Medication Practice, Infection Control, Moving and Handling, 6/09/2022
Fire Safety, Safeguarding and Protection of Adult, Food Hygiene

CV attached

4. Part 1 NMC Test

Not yet taken but willing to take

Date Taken

Evidence Attached
5. Health & Disability

The following questions on health and disability are asked in order to find out your needs in terms of reasonable adju

Do you have any health issues or a disability relevant which may make it difficult for you to carry out functions which a

If yes, please specify

If you have a disability, what are your needs in terms of reasonable adjustments in order to access this recruitment se

Please specify

6. English Language Requirements

- All applicants must also meet English language requirements, with an International English Language
Test (IELTS) score of 7.0
- Any English Language Test (IELTS) taken more than 2 years ago will be in valid and candidates will
have to retake this exam.
English Language Test Result Grade Date Taken

Note:
- Previously, the aspirants needed to achieve a Level 7 in reading, writing, speaking and listeningin the IELTS Academic Test.
Even now, candidates are required to achieve a Level 7, however,this can now be done over two sittings.Candidates can now
appear for two tests within a span of six months and score a Level 7 atleast once in each category across both the tests, without
scoring less than 6.5 in any category.
- If your score is between 4.5 to 7.0, you are still eligible for 12 months Interim Visa for Band 3 nurses with The Flame Lily.
During this time you will be on a paid work placement as a Band 3 Nurse in our establishment, and whileworking you will be
training to complete your IELTS and NMC registration within these 12 months.The Flame LilyHealthcare will support you
throughout your training till NMC registration. Once you have your NMC registration andIELTS with score7.0 and above, you
can then start applying as Band 5 nurse.
 7. Occupational Health

Please confirm you have had the following immunisations and provide recent serology reports:

HEP B HEP C BCG Date: Date: Date: Date:

Rubella, Measles Date:
Varicella HIV Date:

8. Employment Requirements
Nigeria (I am Currently outside UK and will need sponsor licence)
Country of Origin

Choose one of the fields that is applicable to you.

1. Currently in UK and Will not need sponsor Licence
2. Currently in UK and Will need sponsor licence
3. Currently outside UK and will need sponsor licence

9. Current Employment
Caregiver Volunteer
Current / Most recent employer:

Support woker
Job Title Salary per annum/hour

2021 Till Date

Start Date Leave Date (If Applicable)

Grace Nursing Care

Address Centre, Kurudu Police
Estate, Abuja.

Support woker, Assist

Role Client in Bathing, Oral
Care, Bed Dressing and
assist in their day to day
activities.
10. Referees
Please give the names and addresses of 2 professional referees (at least one of whom we can contact
immediately for a reference). Both referees must have known you in a professional capacity for a minimum of
6 months and one should be your most recent employer.

Primary Referee (Please note this referee will be contacted immediately)

Grace Nursing Care Centre (GNCC)
Organisation Name
Rev Arc. Victoria Onu
Contact Name
CEO and Founder Grace Nursing Care Centre
Job Title / Position within the company
Kurudu Police Estate Abuja.
Organisation Address

+2348022237463 gncchasct@gmail.com Length of

Telephone Email
+2348130705810 time known

Is this your Current Employer/ Previous Employer (Current Employer)

Secondary Referee

Divine Mercy Chamber

Organisation Name
Barrister Timothy Bonett
Contact Name
Owner Divine Mercy Chamber
Job Title / Position within the company

3rd Floor Bakori House Kaduna.

Organisation Address

+2348033908865 timothybonett26@gmail.com Length of

Telephone Email
time known

Is this your Current Employer/ Previous Employer (Previous Employer)

Please indicate if you are happy for us to also contact this employer immediately Yes / No (Yes)
12. Emergency Contact
11. Rehabilitation of Offenders
Sarah John
Title First Name Last Name
Wife
Relationship

Flat, 4 Behind Celestial Church.

Address

+2347035059046
Daytime Tel Evening Tel Mobile

 Convictions will not necessarily be a bar to obtaining a post. However because of the nature of
the work for which you are applying, this post is exempt from the provisions of Section 42 of the
Rehabilitation of Offenders Act 1974. Applicants must declare information about convictions,
cautions, reprimands and final warnings, for which other purposes are “spent” under the
provisions of the Act.

YES ☐ NO ☐

 Have you ever been convicted, cautioned, reprimanded or given a final warning for a
criminal offence? NO

 Are you waiting to hear about any pending prosecutions? NO

 Are you aware of any police enquiries undertaken following allegations made against you, which
may have a bearing on your stability for this post? NO

 Have you ever been subject of a disciplinary investigation or proceedings by a previous employer?
NO

 Do you currently hold a police report from country of origin?

YES ☐ NO ☐ NO

- Proof Attached ☐
 The information that you provide on this form and on any CV given will be used by The Flame Lily
Healthcare
13. ltd to provideGDPR
Data Protection/ you work finding services. In case of working with vulnerable persons and
where professional qualifications / authorisations are required by law, we will offer to provide details of
both your references and qualifications to the clients. In providing this service to you, you consent to your
personal data being included on a computerised database and consent to us transferring your personal
details to our clients.

We may check the information collected, with third parties or with other information held by us.
We may also use or pass to certain third parties information to prevent or detect crime, to protect public
funds, or in other way permitted or required by law.

I consent to the Company processing the above personal data and Sensitive Personal Data for the
following purposes:

 For the Company to provide me with work-finding services.

 For the Company to process with or transfer my personal data to their client/s in order to provide me
with work-finding services.
 For the Company to process my data on a computerised database in order to provide me with work-
finding services.
 For the Company to process my data using automated decision making processes.
 Any other relevant purposes for processing personal data & sensitive data for me to meet the
obligations/ requirement of my job and placement

I also consent to the Company processing my personal data with third parties including auditors,
framework providers and contracts management companies 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.

The consent I give to the Company will last for 7 years.

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 in writing.

☐  I give my consent to the Flame Lily.

 I hereby confirm that the information given is true and correct. I consent to my personal data and CV
14. Your Declaration
being forwarded to clients. I consent to references being passed onto potential employers. I can confirm
I have good use and command of the English Language.

If, during the course of a temporary assignment, the Client wishes to employ me direct, I acknowledge
that The Flame Lily Healthcare Ltd will be entitled either to charge the client an introduction/transfer fee,
or to agree an extension of the hiring period with the Client (after which I may be employed by the
Client without further charge being applicable to the Client).

Signed

Francis John Kanwai

Date 24/10/2022

Returning the form

Please return this form together with a copy of your full CV.

By Post : By Email:
internationalrecruit@theflamelily.co.uk
House of The Flame Lily
International Recruitment Enquiries:
Department 144 Penn Road Telephone : 03334560120
Wolverhampton WV3 0EE Fax : 08704285992
UK