Clinical Services Application

Clinical Services Application

Please complete the registration form below, making sure to fill out all fields. Please upload a CV and any relevant certificates as proof of your qualifications.



Personal Details










Contact Details
















Your Skills













Upload Your Certificates

Upload your Certificates in either PDF, MSWord  or image formats.

Please make sure that your certificates are saved with your full name before you upload.

If you are using a smartphone or tablet computer (ie iPad, iPhone, Android), your device may not allow you to attach your CV here. If you are unable to use a desktop computer to submit your registration.






Your CV

Upload your CV in either PDF or MSWord format.

Please make sure that your CV is saved with your full name before you upload.

If you are using a smartphone or tablet computer (ie iPad, iPhone, Android), your device may not allow you to attach your CV here. If you are unable to use a desktop computer to submit your registration, please have your CV ready to send to us by email when we contact you.






Declaration

I declare that the information given by me on this application form to be accurate and correct. I can confirm that I am of sound physical and mental health and accept full responsibility for maintaining my general fitness to practise. I understand that the agency encourages me to benefit from professional indemnity insurance. I am entitled to take up paid employment in the UK.

I agree to complete an application at an enhanced level to the DBS. This will include a check against the children and adult barred list. I also agree to complete a pre-registration health declaration and full immunisation check in accordance with the Department Of Health and NHS employer guidelines.

I understand that in this form I may have supplied information which constitutes sensitive personal data, as defined in the data protection act 1998. I give my consent to the agency to process such data for the purposes of Health and Safety and also as may be necessary for NHS audit, law and tax enforcement or assessment processes. I consent to such information being passed on to such persons as shall be necessary for the purpose of assessing my suitability for an assignment.

Personal details of unsuccessful applicants may be retained for future jobs/correspondence.