Candidate Information

Online Application

Your Details

Emergency Contact

Eligibility of Employment

Equal Opporunities

Mediplacements has an Equal opportunities Policy which is available upon request. For the sole purpose of monitoring our policy please complete the following:


Please give details of where you found out about Mediplacements.

Working Requirements

Working Hours

In line with Government legislation under the terms of 'Working Time Regulations' we recommend that your working hours should not exceed 48 hours per week (averaged over a 17 week period). Should you wish to waive this right, please confirm this by selecting below.

Additional Information

Please list periods of unemployment, gaps in employment, raising of family or educational breaks (details of which should also feature on your CV.


We need to obtain work related references covering the last 3 years employment prior to date of registration. Please provide details of your two most recent employers below.

Reference 1

Reference 2

Declaration of Criminal Convictions

Have you ever been the subject of the following?

Please upload a copy of your CRB/DBS, if you have one, at the bottom of this page.

File Uploads

Please make sure you upload the following:

  • Proof of ID (Passport, Birth Certificate Proof of Address, and proof of NI Number)
  • Proof of eligibility to work in the UK.
  • Qualifications certificates.
  • Passport style photo (can be a digital file).
  • Professional Registration Certificate (eg. HCPC)
  • Current CV.

Please note: Before being eligible for work we must view original versions of these documents. A consultant will contact you after registration to organise this step.

Please be aware if your attachments exceed 14mb (in total) this may result in the failure of your submission, if this should happen please go back one step and reduce the number attachments/file sizes accordingly.

Once you have successfully submitted your registration, you will receive an automatically generated email confirming this.


General Data Protection Regulation (GDPR) and Contact Consent.

All personal data provided by you (the applicant) will be treated as confidential and stored / managed on our secure servers. We do however require your consent to process and transmit your information to third parties for the purpose of finding you suitable employment and obtaining essential supporting documentation. This consent covers all information we may require whilst representing you; including but not limited to your application, training & compliance, work placements, payroll and general day-to-day correspondence.

Temporary work dictates the need for quick, effective communication for us to secure assignments for you. It is therefore essential for us to maintain regular contact with you across multiple channels. This includes; phone, Email, SMS and in-app push notifications (where applicable). Your consent is required for us to do so.

We take data privacy and security very seriously and your personal information will be processed and secured in accordance with The General Data Protection Regulations (GDPR). Our privacy policy can be viewed here

Once registered you can manage your correspondence / marketing preferences by logging into our Privacy Hub at; Please be mindful that removing or limiting methods of contact could potentially reduce our response time, which in turn may result in you missing out on work opportunities.


I declare that the details given by me on this application form are correct to the best of my knowledge and belief. I understand that if I have given any information which is false, or I withhold any relevant information, this may lead to my application being rejected, or if already appointed, to my dismissal.

I authorise Mediplacements to disclose any convictions declared in this registration document to any potential employers in accordance with the DBS Code of Practice and the Rehabilitation of Offenders Act.

By selecting 'YES' below I also declare that I have read the Mediplacements candidate handbook and accept the Terms & Conditions of Business.