Personal Information

Work Information

Your Preferences

Professional Qualifications & Trainings Attended

For RNs only

Note: Argante Care Ltd. will verify all certificates you provide.

Work History

Please fill in the blanks in block letters (all uppercase), starting with the most recent work experience

Professional Indemnity Insurance

Argante Care Ltd. strongly encourages applicants to have their own Professional Indemnity Insurance.

If you answered “NO”, we strongly advise contacting an accredited organisation to arrange this for you.

How did you hear about us


Provide two (2) Employment Referees and two (2) Character Referees

Criminal Records

The work you have applied for is exempt from the Rehabilitations of Offenders Act 1974, which means that all convictions, cautions, reprimands and final warnings on your criminal record need to be disclosed. You are NOT entitled to withhold information about convictions, which for other purposes may be considered spent. Only relevant convictions and other information will be taken into account so disclosure need not necessarily be bar to obtaining work with Argante Care Ltd. Please tick:

Please note that if at any stage whilst working for Argante Care Ltd. we receive a DBS Disclosure that highlights information you have not declared, you will be removed from your assignment.


I understand that if I am charged or cautioned after signing this declaration, I must inform Argante Care.

1. Have you ever been subject to disciplinary action or are currently being investigated due to alleged misconduct?

2. I declare that the information given herein is true and complete and is not presented in a way intended to mislead. I agree that if I have given false or misleading information or omit to give relevant information now or in the future, that Argante Care may cease to offer me further agency placements without notice, as well as a claim for recovery of any payments I have received, together with a claim for a loss of profit to Argante Care.

3. I acknowledge and confirm that Argante Care is authorised to apply for and obtain a disclosure from the Disclosure and Barring Service, and references from any previous employers and educational establishments.

4. I acknowledge that my personal details will be stored and handled correctly by Argante Care in accordance with the Data Protection Act 2018 and I agree that they may be made available for audit/review by relevant third parties. (This is relevant for all information including all documents - DBS, Occupational Health, References).

5. I understand that if I am on a Tier 2 Sponsorship Visa, I can only work for a maximum of 20 hours per week at the same professional level as my sponsorship. I understand that I have a responsibility to monitor this. In addition, if my position with my sponsored company changes, I must inform Argante Care.

6. I understand that if I am a student I can only work for 20 hours per week during term time. I understand that I have a responsibility to monitor this. In addition, if my position as a student changes, I must inform Argante Care.

7. I acknowledge that if any of my details stated on this Application Form change, or my circumstances change, which may affect my ability to work as a nurse or as a care assistant, I must inform Argante Care immediately.

8. I confirm that I am not currently under investigation, or currently suspended, by my professional regulatory body (eg. NMC/HPC) or being investigated by my current or previous employer. I will inform Argante Care if I am under investigation or suspended by my professional regulatory body or employer at any point whilst working for Argante Care.

9. I confirm that when asked about my working history (primarily, but not exclusively, for the purposes of the Agency Workers Regulations) I will provide accurate information.

10. I acknowledge that should I reach the 12 week Qualifying Period under the Agency Workers Regulations, I may be asked for, and will provide, further documentation as evidence of qualifying weeks, if Argante Care deem it necessary.

Final Statement and Declaration

I understand that acceptance onto the Argante Care Ltd. register may only be granted after relevant checks are made, satisfactory references are received and I have attended an interview or induction.

If during the course of a temporary assignment, the Client wishes to employ me direct, I acknowledge that Argante Care Ltd will be entitled either to charge the Client a referral/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).

Note : “if you have completed this form online” please put the word “online”