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Eyears Staff Application

Please take your time to fill out the application as fully as possible, then press send application to send your details to us, and we will get back to you to arrange an interview. You can expand or hide a section of the online form by clicking the + or - icons. Failure to provide basic information will result in your application being rejected.

If you have a C.V. that you would like to send, please append the document onto the application using the CV Uploader tool.

Applying for

Personal Details


Please enter your qualifications into the fields below.

Qualification #1

Qualification #2

Qualification #3

Qualification #4

Qualification #5


Please provide contact details for 3 referees, one of which must be your last or present Employer and should cover 5 years. If you have just left education/college, provide details of your tutor and last 2 placements.

Referee 1

Referee 2

Referee 3

Referee 4

Referee 5


Employment Details

Contact details of your last or current Employer.

(plus any benefits)
(daily duties, activities & areas of responsibility )
Prior Employment Details

Employer #1

Employer #2

Employer #3

Employer #4

Employer #5

Bank Details
(8 digits)
(6 digits)
(Max 20 digits)

Please indicate which courses you have attended in the last 12 months.

Moving and handling

Health and safety

Adult / Newborn CPR

Food Hygiene

From time to time it may be required to disclose certain information regarding your application to place you into assignments. Please be assured only information that is absolutely necessary will be disclosed. We would appreciate it if you would amend the statement below to declare your wishes. IF you have any concerns, please do Not hesitate to contact us.

To have my information disclosed should it be required in the placement on assignments.

Medical Fitness to Work
Eligibility to work within the UK
Rehabilitation of Offenders Act 1974

The Rehabilitation of Offenders Act 1974 (exception order 75) states that the Act does Not apply to any employment which is concerned in the provision of health services, or which is likely to enable the holder to have access to persons in receipt of such services in their duties.


DBS Disclosure

Eyears check, record & monitor the DBS status of all applicants where it is warranted or legislated. This will either take form of a brand new DBS check or utilisation of the DBS Update Service. Full details of the service can be found HERE. Eyears will check at regular intervals to ensure this status is still valid.

By submitting your application to Eyears you agree to this process and procedure prior to offer of employment.

Working Time Directive

The current limit for working hours within the European Union is 48 hours per week. You are under No obligation to accept work offered to you and will never be instructed to work more than 48 hours per week, however you may choose to do so. Please confirm you have read and understood this information and indicate your desired choice below.

..wish to work more than 48 hours per week.

Work Preference

If so which agencies did you register with?

Agency #1

Agency #2

Agency #3

Agency #4

Agency #5

Availability For Work

Curriculum Vitae


We may wish to contact you to ask for your opinion or view regarding our services. This may be via telephone, letter, email or other media as available.

We may contact you to work with details of work, via telephone, letter, email or other media available.

Terms and Conditions

I have read, understood and accepted the terms and conditions and give my consent to Eyears Ltd recording my details in accordance with their privacy policy *

By sending this application, I declare the information in this application to be true & correct. I understand that if any of the data is untrue, misleading or I have failed to declare facts, future employment offers may be withheld or removed without Notice.

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Accreditations | Crown Commercial Service Supplier, Birmingham City Council partner, APSCo Accredited, FSB member.