{"id":1991,"date":"2024-05-09T13:09:06","date_gmt":"2024-05-09T13:09:06","guid":{"rendered":"https:\/\/remitystaffing.cumulative-projects.com\/?page_id=1991"},"modified":"2024-06-20T13:05:01","modified_gmt":"2024-06-20T13:05:01","slug":"non-clinical-application-form","status":"publish","type":"page","link":"https:\/\/www.remitystaffing.com\/india\/non-clinical-application-form\/","title":{"rendered":"Remity Staffing &#8211; Non Clinical Application Form"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-post\" data-elementor-id=\"1991\" class=\"elementor elementor-1991\">\n\t\t\t\t<div class=\"elementor-element elementor-element-1337320 e-flex e-con-boxed e-con e-parent\" data-id=\"1337320\" data-element_type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t<div class=\"elementor-element elementor-element-8c47842 e-con-full e-flex e-con e-child\" data-id=\"8c47842\" data-element_type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-6020073 elementor-widget elementor-widget-heading\" data-id=\"6020073\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Remity Staffing - Non Clinical Application Form<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-d6ed0c3 e-flex e-con-boxed e-con e-parent\" data-id=\"d6ed0c3\" data-element_type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t<div class=\"elementor-element elementor-element-d91fcb1 e-flex e-con-boxed e-con e-child\" data-id=\"d91fcb1\" data-element_type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-6ece17a elementor-widget elementor-widget-shortcode\" data-id=\"6ece17a\" data-element_type=\"widget\" data-widget_type=\"shortcode.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-shortcode\">\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f1986-o1\" lang=\"en-US\" dir=\"ltr\" data-wpcf7-id=\"1986\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/india\/wp-json\/wp\/v2\/pages\/1991#wpcf7-f1986-o1\" method=\"post\" class=\"wpcf7-form init cf7skins cf7s-default\" aria-label=\"Contact form\" novalidate=\"novalidate\" data-status=\"init\">\n<div style=\"display: none;\">\n<input type=\"hidden\" name=\"_wpcf7\" value=\"1986\" \/>\n<input type=\"hidden\" name=\"_wpcf7_version\" value=\"6.0.6\" \/>\n<input type=\"hidden\" name=\"_wpcf7_locale\" value=\"en_US\" \/>\n<input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f1986-o1\" \/>\n<input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/>\n<input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/>\n<input type=\"hidden\" name=\"_wpcf7cf_hidden_group_fields\" value=\"[]\" \/>\n<input type=\"hidden\" name=\"_wpcf7cf_hidden_groups\" value=\"[]\" \/>\n<input type=\"hidden\" name=\"_wpcf7cf_visible_groups\" value=\"[]\" \/>\n<input type=\"hidden\" name=\"_wpcf7cf_repeaters\" value=\"[]\" \/>\n<input type=\"hidden\" name=\"_wpcf7cf_steps\" value=\"{}\" \/>\n<input type=\"hidden\" name=\"_wpcf7cf_options\" value=\"{&quot;form_id&quot;:1986,&quot;conditions&quot;:[{&quot;then_field&quot;:&quot;group-500&quot;,&quot;and_rules&quot;:[{&quot;if_field&quot;:&quot;radio-non_clinical&quot;,&quot;operator&quot;:&quot;equals&quot;,&quot;if_value&quot;:&quot;Type&quot;}]}],&quot;settings&quot;:{&quot;animation&quot;:&quot;yes&quot;,&quot;animation_intime&quot;:200,&quot;animation_outtime&quot;:200,&quot;conditions_ui&quot;:&quot;normal&quot;,&quot;notice_dismissed&quot;:false,&quot;notice_dismissed_rollback-cf7-5.9.3&quot;:true,&quot;notice_dismissed_rollback-cf7-5.9.5&quot;:true}}\" \/>\n<\/div>\n<div class=\"uacf7-form-1986  \"><div class=\"formbox\">\n\t\t<div class=\"row\">\n\t\t\t\t<div class=\"col-full\">\n\t\t\t\t\t\t<h3>Remity Staffing: Application form for Non clinical Staff<\/h3>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"col-three\">\n\t\t\t\t\t<label>Title<span class=\"required\">*<\/span><\/label>\n\t\t\t\t\t<span class=\"wpcf7-form-control-wrap\" data-name=\"title\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required form-control\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"title\" \/><\/span>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"col-three\">\n\t\t\t\t\t\t<label>First<span class=\"required\">*<\/span><\/label>\n\t\t\t\t\t<span class=\"wpcf7-form-control-wrap\" data-name=\"firstName\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required form-control\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"firstName\" \/><\/span>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"col-three\">\n\t\t\t\t\t\t<label>Last<span class=\"required\">*<\/span><\/label>\n\t\t\t\t\t\t<span class=\"wpcf7-form-control-wrap\" data-name=\"lastName\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required form-control\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"lastName\" \/><\/span>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"col-half\">\n\t\t\t\t\t\t<label>Address Line 1<span class=\"required\">*<\/span><\/label>\n\t\t\t\t\t\t<span class=\"wpcf7-form-control-wrap\" data-name=\"address_1\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required form-control\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"address_1\" \/><\/span>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"col-half\">\n\t\t\t\t\t\t<label>Address Line 2<span class=\"required\">*<\/span><\/label>\n\t\t\t\t\t\t<span class=\"wpcf7-form-control-wrap\" data-name=\"address_2\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required form-control\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"address_2\" \/><\/span>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"col-three\">\n\t\t\t\t\t\t<label>City<span class=\"required\">*<\/span><\/label>\n\t\t\t\t\t\t<span class=\"wpcf7-form-control-wrap\" data-name=\"city\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required form-control\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"city\" \/><\/span>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"col-three\">\n\t\t\t\t\t\t<label>Postal\/Zip Code<span class=\"required\">*<\/span><\/label>\n\t\t\t\t\t\t<span class=\"wpcf7-form-control-wrap\" data-name=\"pin_code\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required form-control\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"pin_code\" \/><\/span>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"col-three\">\n\t\t\t\t\t\t<label>Country<span class=\"required\">*<\/span><\/label>\n\t\t\t\t\t\t<span class=\"wpcf7-form-control-wrap\" data-name=\"country\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-countrytext wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-countrytext form-control\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"country\" \/><\/span>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"col-half\">\n\t\t\t\t\t\t<label>Tel Home<\/label>\n\t\t\t\t\t\t<span class=\"wpcf7-form-control-wrap\" data-name=\"home\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-tel wpcf7-text wpcf7-validates-as-tel form-control\" aria-invalid=\"false\" value=\"\" type=\"tel\" name=\"home\" \/><\/span>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"col-half\">\n\t\t\t\t\t\t<label>NI Number<span class=\"required\">*<\/span><\/label>\n\t\t\t\t\t\t<span class=\"wpcf7-form-control-wrap\" data-name=\"number\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required form-control\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"number\" \/><\/span>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"col-half\">\n\t\t\t\t\t\t<label>Mobile<span class=\"required\">*<\/span><\/label>\n\t\t\t\t\t\t<span class=\"wpcf7-form-control-wrap\" data-name=\"mobile\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-tel wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-tel form-control\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"tel\" name=\"mobile\" \/><\/span>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"col-half\">\n\t\t\t\t\t\t<label>Email<span class=\"required\">*<\/span><\/label>\n\t\t\t\t\t\t<span class=\"wpcf7-form-control-wrap\" data-name=\"email\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-email wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-email form-control\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"email\" name=\"email\" \/><\/span>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"col-half\">\n\t\t\t\t\t\t<label>Nationality & Visa Type<span class=\"required\">*<\/span><\/label>\n\t\t\t\t\t\t<span class=\"wpcf7-form-control-wrap\" data-name=\"nationality\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required form-control\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"nationality\" \/><\/span>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"col-half\">\n\t\t\t\t\t\t<label>DOB<span class=\"required\">*<\/span><\/label>\n\t\t\t\t\t\t<span class=\"wpcf7-form-control-wrap\" data-name=\"dob\"><input class=\"wpcf7-form-control wpcf7-date wpcf7-validates-as-required wpcf7-validates-as-date form-control\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"DOB\" value=\"\" type=\"date\" name=\"dob\" \/><\/span>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"col-three\">\n\t\t\t\t\t\t<div class=\"radio_checkbox\">\n\t\t\t\t\t\t\t<label>COVID VACCINATIONS<\/label>\n\t\t\t\t\t\t\t<span class=\"wpcf7-form-control-wrap\" data-name=\"vaccination\"><span class=\"wpcf7-form-control wpcf7-radio multi_options\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"vaccination\" value=\"Yes\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"vaccination\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/label><\/span><\/span><\/span>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"col-three\">\n\t\t\t\t\t\t<label>JAB 1 Date<\/label>\n\t\t\t\t\t\t<span class=\"wpcf7-form-control-wrap\" data-name=\"jab-1\"><input class=\"wpcf7-form-control wpcf7-date wpcf7-validates-as-required wpcf7-validates-as-date form-control\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"date\" name=\"jab-1\" \/><\/span>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"col-three\">\n\t\t\t\t\t\t<label>JAB 2 Date<\/label>\n\t\t\t\t\t\t<span class=\"wpcf7-form-control-wrap\" data-name=\"jab-2\"><input class=\"wpcf7-form-control wpcf7-date wpcf7-validates-as-required wpcf7-validates-as-date form-control\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"date\" name=\"jab-2\" \/><\/span>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"col-three\">\n\t\t\t\t\t\t<div class=\"radio_checkbox\">\n\t\t\t\t\t\t\t<label>DRIVING LICENCE<\/label>\n\t\t\t\t\t\t\t<span class=\"wpcf7-form-control-wrap\" data-name=\"licence\"><span class=\"wpcf7-form-control wpcf7-radio multi_options\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"licence\" value=\"Yes\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"licence\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/label><\/span><\/span><\/span>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"col-three\">\n\t\t\t\t\t\t<div class=\"radio_checkbox\">\n\t\t\t\t\t\t\t<label>CAR OWNER<\/label>\n\t\t\t\t\t\t\t<span class=\"wpcf7-form-control-wrap\" data-name=\"car_owner\"><span class=\"wpcf7-form-control wpcf7-radio multi_options\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"car_owner\" value=\"Yes\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"car_owner\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/label><\/span><\/span><\/span>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"col-three\">\n\t\t\t\t\t\t<div class=\"radio_checkbox\">\n\t\t\t\t\t\t\t<label>DO YOU OWN SAFETY WEAR<\/label>\n\t\t\t\t\t\t\t<span class=\"wpcf7-form-control-wrap\" data-name=\"safty_wear\"><span class=\"wpcf7-form-control wpcf7-radio multi_options\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"safty_wear\" value=\"Yes\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"safty_wear\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/label><\/span><\/span><\/span>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"col-full\">\n\t\t\t\t\t\t<div class=\"radio_checkbox\">\n\t\t\t\t\t\t\t<label>UNSPENT CRIMINAL CONVICTIONS\/CASES PENDING<\/label>\n\t\t\t\t\t\t\t<span class=\"wpcf7-form-control-wrap\" data-name=\"case_pending\"><span class=\"wpcf7-form-control wpcf7-radio multi_options\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"case_pending\" value=\"Yes\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"case_pending\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/label><\/span><\/span><\/span>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"col-full\">\n\t\t\t\t\t\t<label>IF ANY CONVICTIONS, PLEASE LIST HERE?<\/label>\n\t\t\t\t\t\t<span class=\"wpcf7-form-control-wrap\" data-name=\"convictions\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea form-control\" aria-invalid=\"false\" name=\"convictions\"><\/textarea><\/span>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"col-half\">\n\t\t\t\t\t\t<label>HOW DID YOU HEAR ABOUT US<\/label>\n\t\t\t\t\t\t<span class=\"wpcf7-form-control-wrap\" data-name=\"hear\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea form-control\" aria-invalid=\"false\" name=\"hear\"><\/textarea><\/span>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"col-half\">\n\t\t\t\t\t\t<label>PREFERRED LOCATIONS FOR WORK<\/label>\n\t\t\t\t\t\t<span class=\"wpcf7-form-control-wrap\" data-name=\"location\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea form-control\" aria-invalid=\"false\" name=\"location\"><\/textarea><\/span>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"col-half\">\n\t\t\t\t\t\t<div class=\"radio_checkbox\">\n\t\t\t\t\t\t\t<label>ARE YOU A STUDENT<\/label>\n\t\t\t\t\t\t\t<span class=\"wpcf7-form-control-wrap\" data-name=\"student\"><span class=\"wpcf7-form-control wpcf7-radio multi_options\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"student\" value=\"Yes\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"student\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/label><\/span><\/span><\/span>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"col-half\">\n\t\t\t\t\t\t<div class=\"radio_checkbox\">\n\t\t\t\t\t\t\t<label>REGISTERED or TEMPED WITH US BEFORE?<\/label>\n\t\t\t\t\t\t\t<span class=\"wpcf7-form-control-wrap\" data-name=\"registered\"><span class=\"wpcf7-form-control wpcf7-radio multi_options\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"registered\" value=\"Yes\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"registered\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/label><\/span><\/span><\/span>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"col-full\">\n\t\t\t\t\t\t<div class=\"radio_checkbox\">\n\t\t\t\t\t\t\t<label>Flu Vaccination Declaration (Have you received your Flu jab within last 12 months)<\/label>\n\t\t\t\t\t\t\t<span class=\"wpcf7-form-control-wrap\" data-name=\"flu_vacine\"><span class=\"wpcf7-form-control wpcf7-radio multi_options\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"flu_vacine\" value=\"Yes\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"flu_vacine\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/label><\/span><\/span><\/span>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"col-half\">\n\t\t\t\t\t\t<label>Date Vaccination taken<\/label>\n\t\t\t\t\t\t<span class=\"wpcf7-form-control-wrap\" data-name=\"vaccination_taken\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text form-control\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"vaccination_taken\" \/><\/span>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"col-half\">\n\t\t\t\t\t\t<label>If you have not taken Flu vaccination please explain reason.<\/label>\n\t\t\t\t\t\t<span class=\"wpcf7-form-control-wrap\" data-name=\"vaccination_not_taken\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text form-control\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"vaccination_not_taken\" \/><\/span>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"col-half\">\t\t\t\t\t\n\t\t\t\t\t\t<label>Next of Kin or Emergency Contact Name<span class=\"required\">*<\/span><\/label>\n\t\t\t\t\t\t<span class=\"wpcf7-form-control-wrap\" data-name=\"emergency_contact_name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required form-control\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"emergency_contact_name\" \/><\/span>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"col-half\">\t\t\t\t\t\n\t\t\t\t\t\t<label>Next of Kin or Emergency Contact Mobile Number<span class=\"required\">*<\/span><\/label>\n\t\t\t\t\t\t<span class=\"wpcf7-form-control-wrap\" data-name=\"emergency_contact_number\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-tel wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-tel form-control\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"tel\" name=\"emergency_contact_number\" \/><\/span>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"col-half\">\t\t\t\t\t\n\t\t\t\t\t\t<label>Next of Kin or Emergency Contact Relationship with you<span class=\"required\">*<\/span><\/label>\n\t\t\t\t\t\t<span class=\"wpcf7-form-control-wrap\" data-name=\"emergency_relationship\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required form-control\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"emergency_relationship\" \/><\/span>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"col-full\">\n\t\t\t\t\t\t<h6>YOU CONFIRM: <\/h6>\n\t\t\t\t\t\t<ol>\n\t\t\t\t\t\t\t\t<li>You Have Received Our Worker's Handbook Which Details Our Service To You.<\/li>\n\t\t\t\t\t\t\t\t<li> Information Provided Is Correct & In Particular You Have The Qualifications & Abilities You Have Detailed.<\/li>\n\t\t\t\t\t\t\t\t<li>You Are Happy For Us To Share Your Details With Clients To Secure Work And With Framework Authorised Auditord For Compliance.<\/li>\n\t\t\t\t\t\t\t\t<li>You Are Happy For Us To Contact Your Previous Employers To Seek References.<\/li>\n\t\t\t\t\t\t\t\t<li>You Confirm To Work More Than 48 Hours In A Week If Require.<\/li>\n\t\t\t\t\t\t\t\t<li>Your Are Happy For Us To Conduct A Dbs Check If Required By The Client For Any Position.<\/li>\n\t\t\t\t\t\t\t\t<li>You Confirm That Received Nisi Handbook And Understood It<\/li>\n\t\t\t\t\t\t<\/ol>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"col-half\">\n\t\t\t\t\t<div class=\"formgroup sing\">\n\t\t\t\t\t\t<label>Signature<span class=\"required\">*<\/span><\/label>\n\t\t\t\t\t\t<div class=\"dscf7_signature\">\n\t\t\t<div class=\"dscf7_signature_inner\">\n\t\t\t\t<canvas id=\"digital_signature-pad_non-clinical\" name=\"non-clinical\" class=\"digital_signature-pad\" color=\"#000000\" backcolor=\"#FAFAFA\" width=\"460\" height=\"200\"><\/canvas>\n\t\t\t\t<input class=\"clearButton\" type=\"button\" value=\"+\">\n\t\t\t<\/div>\n\t\t\t<span class=\"wpcf7-form-control-wrap non-clinical\">\n\t\t\t\t<input class=\"wpcf7-form-control wpcf7-signature wpcf7-validates-as-requiredwpcf7-validates-as-signature form-controldscf7-signature\" value=\"\" type=\"hidden\" name=\"non-clinical\"\/>\n\t\t\t\t<input type=\"hidden\" name=\"non-clinical-attachment\" class=\"wpcf7_input_non-clinical_attachment\"\/>\n\t\t\t\t<input type=\"hidden\" name=\"non-clinical-inline\" class=\"wpcf7_input_non-clinical_inline\"\/>\n\t\t\t<\/span>\n\t\t<\/div>\n\t\t\t\t\t\t<div class=\"radio_checkbox\">\n\t\t\t\t\t\t\t<span class=\"wpcf7-form-control-wrap\" data-name=\"radio-non_clinical\"><span class=\"wpcf7-form-control wpcf7-radio multi_options\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"radio-non_clinical\" value=\"Draw\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">Draw<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"radio-non_clinical\" value=\"Type\" \/><span class=\"wpcf7-list-item-label\">Type<\/span><\/label><\/span><\/span><\/span>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<span data-id=\"group-500\" data-orig_data_id=\"group-500\" data-clear_on_hide data-class=\"wpcf7cf_group\">\n\t\t\t\t\t\t\t<input type=\"text\" name=\"sign_text form-control\" id=\"sign_text\" \n\t\t\t\t\t\t\t\t\t\t oninput=\"changeFont(this,'digital_signature-pad_non-clinical')\">\n\t\t\t\t\t\t<\/span>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"col-half\">\n\t\t\t\t\t\t<label>Date<span class=\"required\">*<\/span><\/label>\n\t\t\t\t\t\t<span class=\"wpcf7-form-control-wrap\" data-name=\"date\"><input class=\"wpcf7-form-control wpcf7-date wpcf7-validates-as-required wpcf7-validates-as-date form-control\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"date\" name=\"date\" \/><\/span>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"col-full\">\n\t\t\t\t\t\t<h3> REFERENCES <\/h3>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"col-full\">\n\t\t\t\t\t\t<h6 class=\"mb-3\">REFERENCE 1<\/h6>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"col-half\">\n\t\t\t\t\t\t<label>FULL NAME<\/label>\n\t\t\t\t\t\t<span class=\"wpcf7-form-control-wrap\" data-name=\"fullName\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text form-control\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"fullName\" \/><\/span>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"col-half\">\n\t\t\t\t\t\t<label>Organisation<\/label>\n\t\t\t\t\t\t<span class=\"wpcf7-form-control-wrap\" data-name=\"organisation\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text form-control\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"organisation\" \/><\/span>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"col-half\">\n\t\t\t\t\t\t<label>Email<\/label>\n\t\t\t\t\t\t<span class=\"wpcf7-form-control-wrap\" data-name=\"email1\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-email wpcf7-text wpcf7-validates-as-email form-control\" aria-invalid=\"false\" value=\"\" type=\"email\" name=\"email1\" \/><\/span>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"col-half\">\n\t\t\t\t\t\t<label>Tel<\/label>\n\t\t\t\t\t\t<span class=\"wpcf7-form-control-wrap\" data-name=\"tel\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-tel wpcf7-text wpcf7-validates-as-tel form-control\" aria-invalid=\"false\" value=\"\" type=\"tel\" name=\"tel\" \/><\/span>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"col-half\">\n\t\t\t\t\t\t<label>Period Worked<\/label>\n\t\t\t\t\t\t<span class=\"wpcf7-form-control-wrap\" data-name=\"period_worked\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text form-control\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"period_worked\" \/><\/span>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"col-half\">\n\t\t\t\t\t\t<label>Your Role<\/label>\n\t\t\t\t\t\t<span class=\"wpcf7-form-control-wrap\" data-name=\"role\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text form-control\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"role\" \/><\/span>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"col-full\">\n\t\t\t\t\t\t<h6 class=\"mb-3\">REFERENCE 2<\/h6>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"col-half\">\n\t\t\t\t\t\t<label>FULL NAME<\/label>\n\t\t\t\t\t\t<span class=\"wpcf7-form-control-wrap\" data-name=\"fullName2\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text form-control\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"fullName2\" \/><\/span>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"col-half\">\n\t\t\t\t\t\t<label>Organisation<\/label>\n\t\t\t\t\t\t<span class=\"wpcf7-form-control-wrap\" data-name=\"organisation2\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text form-control\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"organisation2\" \/><\/span>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"col-half\">\n\t\t\t\t\t\t<label>Email<\/label>\n\t\t\t\t\t\t<span class=\"wpcf7-form-control-wrap\" data-name=\"email2\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-email wpcf7-text wpcf7-validates-as-email form-control\" aria-invalid=\"false\" value=\"\" type=\"email\" name=\"email2\" \/><\/span>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"col-half\">\n\t\t\t\t\t\t<label>Tel<\/label>\n\t\t\t\t\t\t<span class=\"wpcf7-form-control-wrap\" data-name=\"tel2\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-tel wpcf7-text wpcf7-validates-as-tel form-control\" aria-invalid=\"false\" value=\"\" type=\"tel\" name=\"tel2\" \/><\/span>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"col-half\">\n\t\t\t\t\t\t<label>Period Worked<\/label>\n\t\t\t\t\t\t<span class=\"wpcf7-form-control-wrap\" data-name=\"period_worked2\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text form-control\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"period_worked2\" \/><\/span>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"col-half\">\n\t\t\t\t\t\t<label>Your Role<\/label>\n\t\t\t\t\t\t<span class=\"wpcf7-form-control-wrap\" data-name=\"role2\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text form-control\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"role2\" \/><\/span>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"col-full\">\n\t\t\t\t\t\t<label>What do you consider important in a job, and why?<\/label>\n\t\t\t\t\t\t<span class=\"wpcf7-form-control-wrap\" data-name=\"important_job\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea form-control\" aria-invalid=\"false\" name=\"important_job\"><\/textarea><\/span>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"col-full\">\n\t\t\t\t\t\t<label>What are your strengths in relation to this job role?<\/label>\n\t\t\t\t\t\t<span class=\"wpcf7-form-control-wrap\" data-name=\"strengths\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea form-control\" aria-invalid=\"false\" name=\"strengths\"><\/textarea><\/span>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"col-full\">\n\t\t\t\t\t\t<label>What kind of people do you find most difficult to work with, and why?<\/label>\n\t\t\t\t\t\t<span class=\"wpcf7-form-control-wrap\" data-name=\"difficult\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea form-control\" aria-invalid=\"false\" name=\"difficult\"><\/textarea><\/span>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"col-full\">\n\t\t\t\t\t\t<label>What are the problem areas you encounter in your present job? If any<\/label>\n\t\t\t\t\t\t<span class=\"wpcf7-form-control-wrap\" data-name=\"encounter\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea form-control\" aria-invalid=\"false\" name=\"encounter\"><\/textarea><\/span>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"col-full\">\n\t\t\t\t\t\t<label>Are there any on going health issues which we should be aware of?<\/label>\n\t\t\t\t\t\t<span class=\"wpcf7-form-control-wrap\" data-name=\"health_issues\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea form-control\" aria-invalid=\"false\" name=\"health_issues\"><\/textarea><\/span>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"col-full\">\n\t\t\t\t\t\t<label>Any special requirements you may need from the employer?<\/label>\n\t\t\t\t\t\t<span class=\"wpcf7-form-control-wrap\" data-name=\"requirements\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea wpcf7-validates-as-required form-control\" aria-required=\"true\" aria-invalid=\"false\" name=\"requirements\"><\/textarea><\/span>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"col-half\">\n\t\t\t\t\t\t<input class=\"wpcf7-form-control wpcf7-submit has-spinner submit_button\" type=\"submit\" value=\"Send\" \/>\n\t\t\t\t<\/div>\n\t\t<\/div>\n<\/div><\/div><div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n<\/form>\n<\/div>\n<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>Remity Staffing &#8211; Non Clinical Application Form<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_uag_custom_page_level_css":"","site-sidebar-layout":"default","site-content-layout":"page-builder","ast-site-content-layout":"full-width-container","site-content-style":"unboxed","site-sidebar-style":"unboxed","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"disabled","ast-breadcrumbs-content":"","ast-featured-img":"disabled","footer-sml-layout":"","theme-transparent-header-meta":"enabled","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"set","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"footnotes":""},"class_list":["post-1991","page","type-page","status-publish","hentry"],"uagb_featured_image_src":{"full":false,"thumbnail":false,"medium":false,"medium_large":false,"large":false,"1536x1536":false,"2048x2048":false},"uagb_author_info":{"display_name":"admin@remitystaffing.com","author_link":"https:\/\/www.remitystaffing.com\/india\/author\/adminremitystaffing-com\/"},"uagb_comment_info":0,"uagb_excerpt":"Remity Staffing &#8211; 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