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Mystic Recruitment Application Form

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Register Email

1. Applicants Personal Details

2. Next of Kin Details

For Qualified Nurses in the UK

3. Equal Opportunity

Mystic’s commitment is to foster an inclusive environment where every job applicant and employee is treated fairly and without bias. We ensure that no one is discriminated against based on race, colour, nationality, ethnic or national origin, religious beliefs, political opinions, gender, marital status, sexual orientation, or disability. Additionally, no individual should face disadvantages from requirements or conditions that cannot be objectively justified. We regularly review our selection criteria and processes to guarantee that individuals are evaluated and advanced solely on their relevant skills, experience, and qualifications. Every employee is provided with equal opportunities for growth and development within the organization. Our ongoing efforts to maintain and strengthen this policy are a key part of our values. To help us ensure fair implementation and monitoring, we kindly ask you to provide the following information. This request is made purely for the purposes of maintaining and upholding our commitment to equality.

I identify my ethnic origin, nationality, and gender as follows: (Please select one)

4. Qualifications & Trainings

Kindly provide details of your vocational and academic qualifications, starting with the most recent first.

Qualification Institution Date From and To
(MM/YY)

5. Previous Employment History

Kindly provide your current and previous employment history for the last 5 years, starting with the most recent position first.

Position and Employer Email Address (mandatory) Employed From and To
(MM/YY)

6. Character Reference

Kindly provide the details of one character referee. Kindly note that the referee should not be a family member or anyone related to you by blood.

7. Disclosure & Declaration

Have you ever been convicted or cautioned (excluding youth cautions, reprimands, or warnings) in a manner that is not classified as protected under the Ministry of Justice guidelines?

The amendments to the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975, made in 2013 and 2020, identify certain convictions and cautions as 'protected' when applying for specific jobs or participating in certain activities. This means individuals are not required to disclose these convictions or cautions to employers, and if disclosed, employers are prohibited from considering them during the evaluation process. For detailed guidance on whether a particular conviction or caution is classified as 'protected,' individuals can refer to the Ministry of Justice website.

DATA PROTECTION

I consent to Mystic Recruitment retaining this application and any associated data for processing purposes. I also agree that Mystic Recruitment may share these details with authorized third parties as necessary. Furthermore, I acknowledge that my information will be stored for as long as reasonably required, in compliance with the Data Protection Act 1998.

WORKING TIME REGULATIONS 1998

The European Union has established guidelines to ensure safe working hours for all employees. Currently, the maximum allowable working week is set at 48 hours. You are not obligated to accept any offered work and will not be required to work beyond the 48-hour limit; however, you may opt to do so if you wish. For a comprehensive explanation of the Working Time Regulations 1998, please refer to your Staff Handbook. Kindly select the appropriate box below.

8. Verification of Gaps in employment (if any):

I, do confirm that I have been out of work From (DD/MM/YY) To (DD/MM/YY). Kindly specify the reason behind the gap below;

To process your application for employment with Mystic Recruitment, please enclose:

An updated copy of your CV, detailing your qualifications and any relevant training courses you have completed.

A copy of your valid passport along with any visa necessary to establish your eligibility to work in the UK.

Candidates Bank Details

I hereby declare that the information provided in this application is accurate and truthful. I consent Mystic Recruitment receiving and retaining my personal information. I affirm that I have full authority to use the specified bank/building society for the receipt of my wages. Additionally, I wish to opt into the scheme and agree to receive my payslips via email at the address provided in this document.

9. Candidates Declaration:

I hereby confirm that all the details provided are accurate and complete, and that I am eligible to live and work in the United Kingdom. I understand that if any of this information changes, I am required to notify Mystic Recruitment and complete an alternative form. I declare that I have no cautions, reprimands, final warnings, or criminal convictions, except for those covered under the Rehabilitation of Offenders Act 1974. Furthermore, I affirm that I have no criminal history during any stage of my residency over the past five years. I acknowledge that it is my responsibility to disclose any criminal convictions incurred during my employment with Mystic Recruitment to Human Resources or recruitment consultants. I accept that any misrepresentation of facts may result in the refusal of employment, disciplinary action, or dismissal, and potentially, criminal charges. I authorize Mystic Recruitment contact my former employers, educational institutions, government agencies, and personal referees for the verification of the information provided. I consent to Mystic Recruitment using my details for the required Disclosure and Barring Service (DBS) check and understand that an electronic result will be sent directly to the registered body that submitted the application. I am aware that this electronic result may indicate whether my certificate is blank or requires further review, and that the registered body may provide this information to my employer/Mystic Recruitment before I receive my certificate.

48 HOURS OPT OUT AGREEMENT

  1. DEFINITIONS
    1. The following definitions shall apply in this Agreement.
      2. “Employee” means
      “Employer” means Mystic Recruitment of Pentax House South Hill Avenue, South Harrow, Harrow, England, HA2 0DU.
      “Working Week”refers to an average of 48 hours per seven-day period, calculated over a 17-week reference period. 1.2. References to the singular shall include the plural, and references to the masculine shall include the feminine, and vice versa. 1.3. The headings in this Agreement are provided for convenience only and shall not influence or affect the interpretation of its provisions.
  2. RESTRICTION
    1. The Working Time Regulations 1998 (as amended) stipulate that the Employee shall not work more than the specified Working Week unless they provide written consent agreeing to waive this limitation.
  3. CONSENT
    4. The Employee hereby consents that the limitation on the Working Week shall not apply.

    WITHDRAWAL OF CONSENT

    1. The Employee may terminate this Agreement by providing 3 months' written notice.
    2. For clarity, any notice to terminate this Agreement shall not be interpreted as the Employee's resignation or termination of employment.
    3. Upon the expiration of the notice period outlined in Clause 4.1, the Working Week limit shall immediately take effect.
  4. THE LAW
    1. This Agreement shall be governed by and construed in accordance with the laws of England and Wales and shall be subject to the exclusive jurisdiction of the courts of England and Wales

Data Consent Form/GDPR

I, hereby give my consent to Mystic Recruitment to process the following information:

Personal data

Full Name, Date of Birth, Contact Information (including telephone number, email address, and postal address), Employment History, Training and Qualifications, Curriculum Vitae (CV), National Insurance Number, and Any additional relevant personal data required for the job application (e.g., copy of passport, proof of right to work, bank statement or utility bills for address verification, and references).

Sensitive personal data

Disability/Health Conditions Relevant to the Role, Criminal Convictions, and Any Other Relevant Sensitive Personal Data:
  • I consent to the Company processing the above personal data for the following purposes:
    • To provide work-finding services.
    • To process or transfer my personal data to clients for work-finding purposes.
    • To process my data within a computerized database system for work-finding services.
    • Other relevant purposes for processing personal data, including:
    • DBS application
    • Sending reference requests (character and professional)
    • Training provider/company
    • Staff profile (with photo ID) submission to care homes, nursing homes, or clients
    • Suppliers' portals (e.g., e-tips, MORS, Appellia, Matrix, Comensura)
    • Payroll processing for care homes/nursing homes or other clients I wish to work for.
    • Additionally, I consent to the Company processing my personal data with third parties (e.g., HMRC, ICO, REC, GRI, Cohesion, Omni) for internal audits and investigations to ensure compliance with all relevant laws and obligations. This consent is valid for 60 months.

      • I acknowledge that I have the right to withdraw my consent at any time by notifying the Company of my decision

Terms and Conditions of Employment for Employees

THE PARTIES

I, of Address (“the Employee”), referred to throughout this Agreement as "you" and "your" shall be construed accordingly. Mystic Recruitment and Retail Limited registered company no 15825092 of Pentax House South Hill Avenue, South Harrow, Harrow, England, HA2 0DU ("the Company").
  1. DEFINITIONS AND INTERPRETATION

    2. Definitions in this Agreement:

    “Actual Rate of Pay” refers to the rate paid for all time worked during an assignment while the Employee has not completed the Qualifying Period. This amount will be paid weekly in arrears, subject to deductions and any agreed deductions outlined in the relevant Assignment Details Form.
    “Actual QP Rate of Pay” refers to the rate paid to the Employee upon completion of the Qualifying Period. This rate will be applicable for all time worked during an assignment and will be paid weekly in arrears, subject to deductions and any agreed deductions, as detailed in any variation of the relevant Assignment Details Form.
    “Agreed Deductions” means any deductions that the Employee has consented to be made from their pay.
    “Assignment” refers to the services the Employee is to perform for the Client during the period when the Employee is assigned by the Company to work temporarily under the Client's supervision and direction.
    “Assignment Details Form” is the written confirmation provided to the Employee upon acceptance of an Assignment, detailing the assignment particulars.
    “AWR” refers to the Agency Workers Regulations 2010.
    “Calendar Week” signifies any period of seven days commencing with the same day as the first day of the First Assignment.
    “Client” denotes the person, firm, or corporate body, along with any subsidiary or associated entity, for whom the Employee is performing the Assignment.
    The Employee acknowledges that the Company must process personal data to fulfil its obligations under this Agreement and as required by law concerning employment, in compliance with Data Protection Laws. Such processing will primarily serve personnel, administrative, and payroll purposes.
  2. SEVERABILITY
    3. If any provision of this Agreement is deemed unenforceable by a competent authority, that provision shall be severed to the extent of unenforceability, while the remaining provisions of the Agreement shall continue in full force and effect as permitted by applicable laws.
  3. NOTICES
    4. All notices required under this Agreement must be in writing and may be delivered personally or sent via first-class prepaid post to the registered office of the party to whom the notice is being served or any other address provided in writing. Notices will be considered served as follows:
    By hand, when delivered.
    By first-class post, 48 hours after posting.
    By email or facsimile transmission, upon sending.
    Jurisdiction and Governing Law:
  4. JURISDICTION AND GOVERNING LAW
    5. This Agreement shall be governed by and construed in accordance with English law, with both parties irrevocably submitting to the non-exclusive jurisdiction of the Courts of England and Wales.
    The parties to this Agreement confirm that they have read, understood, and agreed to be bound by its terms.
    Signed for and on behalf of the Company
    Date .
    I confirm that I am not subject to any legal restraints which affect my ability to perform my duties under this Agreement.
    Signed by the employee
    Date

Mystic Healthcare Questionnaire

The purpose of this questionnaire is to assess whether you have any health issues that could impact your ability to perform the duties associated with the position you have been offered or potentially pose any risks in the workplace. Based on your responses, we may recommend adjustments or support to facilitate your ability to carry out the role effectively. Our objective is to promote and maintain the health and well-being of all employees. Please note that your responses will be kept on file for a limited time and may be subject to audit. Additionally, your information may be cross-referenced if you are registered on our system through a different employer.
Personal Information
Title and Name Middle Name Surname
Telephone Number GP Name GP Address

Medical Information
Yes No
Do you have any illness, impairment, or disability (physical or psychological) that may affect your work?
Have you ever had any illness, impairment, or disability that may have been caused or exacerbated by your work?
Are you currently receiving treatment (including medication) or awaiting investigations? If yes, please provide further details regarding the condition, treatment, and dates.
Do you believe you may need any adjustments or assistance to help you perform the job?
If you answered "yes" to any of the above questions, you must provide further details. Failure to do so may result in the form being returned or rejected.

Tuberculosis
Clinical diagnosis and management of tuberculosis, along with measures for its prevention and control (NICE 2006) Yes No
Have you lived continuously in the UK for the last 5 years?
If you answered NO to the above, please list all of the countries that you have lived in/visited over the last 5years, including duration of stay and dates.
Have you had a BCG vaccination in relation to Tuberculosis?
If you answered yes, please state when. Date of Vaccination:

Do you have any of the following? Yes No
A cough which has lasted for more than 3 weeks
Unexplained weight loss
Unexplained fever
Have you had tuberculosis (TB) or been in recent contact with open TB

Have you had any of the following immunizations Yes No Date of Vaccination
Triple Vaccination as a child (Diptheria/Tetanus/Whooping cough)
Polio
Tetanus
Hepatitis B (If yes is ticked please give the dates below)

Proof of Immunity (Please send the following)
Varicella Candidate must provide a written statement to confirm that you have had chicken pox or shingles however we strongly advise that you provide serology test result showing varicella immunity.
Tuberculosis We require an occupational health/GP certificate of a positive scar or a record of a positive skin test result (Do not Self Declare)
Rubella, Measles & Mumps Certificate of “two” MMR vaccinations or proof of a positive antibody for Rubella and Measles.
Hepatitis B You must provide a copy of the most recent pathology report showing titre levels of 100lu/l or above.
Proof of Immunity (Please send the following) EPP Candidates Only
Hepatitis B Surface Antigen Evidence of a negative Surface Antigen Test Report must be an identified validated sample. (IVS)
Hepatitis C You must provide a copy of the most recent pathology report showing titre levels of 100lu/l or above.
HIV Evidence of a negative antibody test
Report must be an identified validated sample. (IVS)

Exposure Prone Procedures
Will your role involve Exposure Prone Procedures

Have you had your covid vaccination
Date of first Vaccine
Date of Second Vaccine
If you had your Booster dose, please give a date

Declaration: I declare that the answers to the above questions are true and complete to the best of my knowledge and belief.
Name of the Candidate Signature Date

Night Time Workers’ Health Questionnaire

Are you fit to work night shifts?
The purpose of this questionnaire is to ensure that you are suited to working at night. All the information you provide will be kept confidential.
Type of work /Duration of night work
Full Name
Gender Identity
Date of Birth
Full Address
Job Title
N I number:

Do you suffer from any of the following health conditions? Yes No
Heart of Circulatory Disorders
Stomach or intestinal disorders
Any difficulties sleeping or disorders
Chronic Chest Disorders, especially night-time symptoms are troublesome
Any medical condition requiring medication to be taken to a strict time
Any other health factors that might affect fitness at work
If you have answered “YES” to any of the questions above, you may be asked to seek medical advice or to see the doctor for further assessment.

I, undersigned, that all the statements above are true and complete to the best of my knowledge. I understand that if I have given untrue or misleading information this may result in disciplinary action and/or dismissal. I also hereby confirm that I will notify Mystic Recruitment in writing should there be any changes on my situation in the future.
Name of the Candidate
Signature
Date

Five Years Address History

Please provide your address history for the past five years, from January 2020 to the present, in the boxes below. Kindly ensure there are no gaps in the timeline.
Full Address Date Lived From Date Lived Until

Modern Slavery Policy

  1. Mystic Recruitment is committed to eliminating modern slavery, human trafficking, forced labour, and similar human rights abuses.
  2. Mystic Recruitment is dedicated to ensuring that its staff and any workers it supplies (directly or indirectly) are not subjected to behaviours or threats that may amount to modern slavery, human trafficking, forced labour, or similar human rights abuses.
  3. Mystic Recruitment is dedicated to ensuring that its staff and any workers it supplies (directly or indirectly) are not subjected to behaviours or threats that may amount to modern slavery, human trafficking, forced labour, or similar human rights abuses.
    1. Our leadership team receives detailed training in identifying and addressing concerns related to modern slavery and human trafficking.
    2. Our recruiters and staff involved in procurement and supply chains undergo training courses that include guidance on modern slavery, human trafficking, and broader human rights issues.
    3. All our staff receive awareness-raising information regarding modern slavery and human trafficking to ensure they can bring any concerns to the attention of management.
  4. Any staff, workers, or other parties are strongly encouraged to report any concerns or suspicions to the HR team.
  5. Reports regarding these issues are taken extremely seriously by our management team, who are committed to ensuring that all investigations are prompt and effective. If our investigations reveal any issues, we are committed to taking appropriate action, including but not limited to:
    1. Working with the appropriate organizations to improve standards,
    2. Removing the offending organization from our preferred supplier list,
    3. Reporting the matter to the appropriate law enforcement bodies
  6. We regularly monitor risks in this area using relevant key performance indicators, including:
    1. The percentage of suppliers who sign up to an appropriate code or provide their own modern slavery statements,
    2. The effectiveness of enforcement actions against suppliers who breach policies,
    3. The amount of time spent on audits, re-audits, spot checks, and related due diligence, and
    4. The level of modern slavery training and awareness among our staff.
  7. As part of our ongoing efforts in this area, we publish a modern slavery statement annually.
  8. We also recommend reviewing this policy in conjunction with our other policies, including:
    1. Corporate Social Responsibility Policy
    2. Ethical Procurement Policy,
    3. Anti-Bribery/Corruption Policy, and
    4. Whistle-Blowing Policy
This policy was adopted on 10th February 2024 after approval by our management team and is reviewed annually.

Disciplinary/Dismissal and Grievance Procedure

General Principles

Every step and action will be taken as promptly as possible to address the matter.
The Company will conduct an investigation to establish the facts of the issue and notify you of the outcome.
If you are requested to attend a meeting by the Company, you are expected to make all reasonable efforts to be present.
You have the right to be accompanied to any formal meeting, and the meeting times and locations will be arranged fairly.
Meetings will be conducted in a manner that allows both you and the Company to present your cases before any decision is made.
For any appeal hearings, the Company will ensure that a more senior manager, who was not involved in the initial meeting, will represent the Company (unless the most senior manager was already involved).
Whenever either you or the Company is required to send relevant documents, it will be done in a timely and efficient manner.

Grievance Procedure

If you have a grievance or grievance about your work or the people you work with, you should follow this procedure. In the first instance, you should try to raise the matter informally if possible.
  • Step 1: You must express your dissatisfaction in writing and send it to the Company.
  • Step 2: The Company will invite you to attend a meeting to discuss your grievance.
  • The meeting must not take place unless you have informed the company of basis of grievance.
  • The company has a reasonable opportunity to consider its response to that information
After the discussion, the company will inform you its decision with your right to appeal if you are not satisfied with it.
  • Step 3: If you decide to appeal, you must notify the Company within five working days of your grounds for appeal, and the Company will invite you to a second meeting. The Company will notify you of its final decision following the appeal meeting.
The hearing on the appeal may not be held before the dismissal, discipline will be implemented, but it will be done in a reasonable amount of time.
The Company will notify you of its final decision following the appeal meeting.

Declaration: I have read, understood, and agree to adhere to the procedures and policies outlined above. By signing this agreement, I confirm my commitment to comply with the following:
Disciplinary, Dismissal, and Grievance Procedure, Equal Opportunities Policy and Modern Slavery Policy
Name of the Candidate
Signature
Date

Are you sure you want to submit the form?
Please confirm that all your details are accurate before proceeding.