Application Form

Specialised Training or Course Attended

(6 of 13)

Membership of Professional Bodies

(7 of 13)

Please give details of membership or any professional duties.

Supporting Information

(8 of 13)

Please ensure when completing this section that you demonstrate that you meet the short listing criteria.

References

(9 of 13)

Please give details of two references; one must be your current or most recent Line Manager or school or college. References from family and friends are not acceptable.

Reference #1

Reference #2

Health Declaration

(10 of 13)

Clothier Report

(11 of 13)

Following the publication of "The Clothier Report" from the Department of Health (Beverly Allot Case) several issues have now become very important in pre-employment screening for health care workers. Please consider the following questions very carefully. The information will be assess on an individual basis and positive replies do not automatically exclude you, but we mist be aware of your past/current problems.

Have you ever:

Declaration of Criminal Conviction, Cautions and Bind-Over Orders in Confidence

(12 of 13)

We have a policy on the recruitment of ex-offenders which is available on request. A criminal record will not necessarily be a bar to obtaining a position with Nursing and Caring Direct

Declaration of Abuse Investigation(s)

Declaration and Consent