HR Health & Care Visa Application Form

HR Health & Care Visa Application Form

Purpose: Use this form to apply for employment in a health and care position that may require immigration sponsorship or visa support. Complete all sections fully and sign the certification and authorizations at the end. Incomplete responses may delay consideration.

Personal Information

Nationality: Place of birth:

Passport number: Passport country of issue:

Passport expiry (MM/DD/YYYY):

Position Applied For

Proposed start date (MM/DD/YYYY): Salary / remuneration offered (annual):

Do you require employer sponsorship or visa support? Yes No

Employment History

Employer 1

Employer 2

Education and Professional Qualifications

Graduation date (MM/YYYY):

References (Professional)

Reference 1

Reference 2

Reference 3

Legal Disclosures and Authorizations

At-Will Employment: I understand that submission of this application does not create an employment contract for any specified period. If employed, my employment will be on an at-will basis unless a separate written agreement signed by the employer states otherwise.

Equal Opportunity: I understand the employer is an equal opportunity employer and does not discriminate in hiring based on protected characteristics. Selection will be based on qualifications, licensure, and fit for the role.

Background checks and verification: I authorize the employer and its agents to verify all information provided, including but not limited to employment history, education, professional registrations, and references. I expressly consent to criminal record checks, identity verification, and other pre-employment screening as required for health and care roles.

Immigration and right to work: I certify that the information given about my immigration status is accurate to the best of my knowledge. I authorize the employer to take necessary action to verify immigration documents and to make decisions concerning sponsorship. Completion of this form does not guarantee sponsorship or employment.

Data processing: I acknowledge that personal data supplied on this form will be processed by the employer for recruitment, vetting, and regulatory compliance purposes and retained in accordance with applicable data retention policies.

Supporting Documents

Please indicate which documents you have attached with this application: Passport copy Curriculum vitae / resume Qualification certificates Professional registration evidence Reference letters Occupational health / medical clearance

Applicant Certification and Authorization

I certify that all information provided on this form and in any attachments is true, complete and accurate. I understand that any material misstatement, omission, or falsification may result in refusal of employment, withdrawal of an offer, or termination if discovered after hire.

I authorize all past employers, institutions, professional bodies, and references to disclose information to the employer for the purpose of evaluating my application. I release those parties from liability for such disclosure provided it is made in good faith.

Background check consent: I consent to criminal and regulatory checks as required for the role.

Declarations — Please read and initial each

I declare that I am not subject to any professional sanction, suspension, or pending disciplinary action:

I declare that I do not have any medical condition that would prevent me from performing the essential duties of the job safely:

I agree to comply with all lawful checks, immunisation or health screening required as a condition of employment:

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