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  • Personal Details*

    * = mandatory field for completion

  • Qualifications

    Education & Professional Qualifications

    Please also indicate subjects currently being studied. All qualifications disclosed will be subject to a satisfactory check.
    Up to 11 qualifications can be entered here.

    Relevent Training Courses Attended

    Include in this section any relevant training courses that you have attended or details of courses that you are currently undertaking, together with the date completed or to be completed. Up to 7 training courses can be entered here.

  • Professional Bodies

  • Employment History

    Please record below full details of all your continuous employment history, beginning with your current or most recent employer and working backwards chronologically. If there are any gaps in your employment please ensure a full explanation is given at end of the ‘Employment History’ section.

    IMPORTANT: If you are currently working within an NHS organisation but through an agency, please ensure you name the agency as your employer and not the NHS organisation you are currently contracted to.

    Current Most Recent Employer (reference always required)

  • Monitoring Information*

    NHS organisations recognise the benefits of having a diverse workforce and therefore welcome applications from all sections of the community. In addition to this, under the provisions of the Equality Act 2010, all NHS organisations are required to demonstrate that their recruitment processes are fair and that they are not discriminating against or disadvantaging anyone because of their age, disability, gender reassignment status, marriage or civil partnership status, pregnancy or maternity, race, religion or belief, sex or sexual orientation. Therefore a series of questions need to be raised in order to ascertain who is applying for each position and to ensure that no one is being unfairly discriminated against or disadvantaged.

    This section of the form will be held separately by the trust and will not be used as part of any selection process nor will it be seen by anybody who is interviewing you. The information collected is only used for monitoring purposes in an anonymised format to assist the organisation in analysing the profile and make up of individuals who apply, are shortlisted for and appointed to each vacancy. In this way, they can check that they are complying with the Equality Act 2010.

    Equality Act 2010

    The Equality Act 2010 protects people against discrimination on the grounds of:

    • Their age and sex.
    • Their race which includes colour, nationality, ethnic or national origin.
    • Their religion or belief, including a lack of any belief.
    • Their sexual orientation, be it bisexual, gay, heterosexual and lesbian.

    The Equality Act 2010 also protects people who are married or in a civil partnership.

  • Employment Preference*

  • Role Type*

  • Notice Period

  • Safeguarding*

    This section of the application form will only be viewed by those who need to see it as part of the recruitment process. Any information disclosed will be treated strictly confidential.

    The Rehabilitation of Offenders Act 1974 (as amended) helps rehabilitated ex-offenders back into work by allowing them not to declare criminal convictions after the rehabilitation period set by the Court has elapsed and the convictions become 'spent'. During the rehabilitation period, convictions are referred to as 'unspent' convictions and must be declared to employers.

    The organisation aims to promote equality of opportunity and is committed to treating all applicants for positions fairly and on merit regardless of ethnicity, disability, age, gender or gender re-assignment, religion or belief, sexual orientation, pregnancy or maternity and marriage or civil partnership. The organisation undertakes not to discriminate unfairly against applicants on the basis of a criminal conviction or other information declared.

    You are required to declare all current 'unspent' criminal convictions or cautions (including reprimands and final warnings). You are not required to disclose convictions or cautions which have become 'spent'.

    As part of assessing your application, organisations will only take into account relevant criminal record and other information declared which is relevant to the position being applied for.

    Answering 'yes' to the question below will not necessarily bar you from appointment. This will depend on the relevance of the information you provide in respect of the nature of the position for which you are applying and the particular circumstances.

    Are you currently bound over or do you have any current ‘unspent’ convictions or cautions (including reprimands or warnings) that have been issued by a Court or Court-Martial in the United Kingdom or in any other country?

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