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NHS Scotland Application Form

Candidate identification number (office use only): Please ensure you complete the application form in full as we cannot accept CVs. Please complete with black ink and block capitals. This form will be kept in confidence when completed and returned to us. PART A Application for (Job Title): Job Reference No:

Location:

Candidate ID No:

No applicant will be unfairly discriminated against. We are particularly alert to eliminating discrimination on account of age, cultural/religious/political belief, disability, ethnicity, gender, race, relationship status, sexual orientation, and/or Trade Union membership or stewardship. Only 'Part C' of this form will be made available to short-listing panels. Parts A, B and C would then be used by the interviewing panel if you are selected for interview. Personal Details Surname: Name known: Address: Forename: Title:

Post Code: Contact Telephone Numbers: Evening: E–mail: If we need to, the best way for us to contact you is by: Work Permit Do you need a work permit to take up this post? Working in the UK Are you eligible to work in the UK? Day: Mobile:

Yes Yes

No No

Page 1

NHS Scotland Application Form

Job Reference No: Candidate ID No: Declarations

PART B

Convictions NHS Scotland is exempt from the 1974 Rehabilitation of Offenders Act (Exclusions & Exceptions) (Scotland) Order 2003. This means that unless stated in the job description, person specification or application pack, you must tell us about any previous convictions either classed as ‘spent’ or ‘unspent’. If you are offered employment, any failure to disclose such convictions could result in dismissal or disciplinary action. Any information you give will be considered only in relation to the post for which this application form refers. Information will be verified by Disclosure Scotland for relevant posts. I declare that I have: (a) No previous convictions (b) Previous convictions – details of which are:

Please read the following statements. You will be asked to sign a declaration if you are appointed: • • • • I have completed Parts A to D of this application form and the details I have supplied are, to the best of my knowledge, true and complete; I understand that if appointed to this post the information on this form will be kept as part of my personal file record; I authorise you to obtain references to support this application if I am identified as a preferred candidate; I understand that details of educational qualifications, membership of professional bodies and referee reports may be verified through the establishments and individuals I have indicated; I consent to my details being kept confidentially and used for specific and lawful purposes as specified in the Data Protection Act 1998; I declare that I have no previous convictions, or have identified any I have above. Date: Page 2

• •

Read, agreed and understood (check box)

NHS Scotland Application Form

Application for (Job Title): Location: Qualifications Achieved Subjects

PART C Job Reference No: Candidate ID No:

Type of Qualification eg. Standard Grade, GCSE, Higher, BSc

Grade Achieved

Qualifications Currently Studying or Working Towards Type of Qualification Subjects eg. Standard Grade, GCSE, Higher, BSc

Grade Anticipated

Date Anticipated

Membership of Professional or Regulatory Bodies Full name of organisation(s) Registration Number

Renewal Date

Page 3

NHS Scotland Application Form

Job Reference No: Candidate ID No: Present (or most recent) Post Job Title: Grade: Employer: Dates of Employment: From: To: Date of Starting Grade:

PART C

Reason for Leaving (if applicable): Notice Period: Current Salary:

Role Purpose / Summary of Responsibilities

Employment History Start with your most recent employment first and work down the page. If a job supports the position applied for, please say more about it in your Application Support Statement. Job Title...
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