12.07.2015 Views

View Application Form - Day in the Life

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If yes, please give detailsIf you are apply<strong>in</strong>g for a post <strong>in</strong>volv<strong>in</strong>g access to persons <strong>in</strong> receipt of health services, your offer of employment may be subject to a satisfactorydisclosure from <strong>the</strong> Crim<strong>in</strong>al Records Bureau. Failure to reveal <strong>in</strong>formation relat<strong>in</strong>g to any convictions could lead to withdrawal of an offer ofemployment.RelationshipsIf you are related to a director, or have a relationship with a director or employee of an appo<strong>in</strong>t<strong>in</strong>g organisation, please state <strong>the</strong> relationship* DECLARATIONThe <strong>in</strong>formation <strong>in</strong> this form is true and complete. I agree that any deliberate omissions, falsification or misrepresentation <strong>in</strong> <strong>the</strong> application formwill be grounds for reject<strong>in</strong>g this application or subsequent dismissal if employed by <strong>the</strong> organisation. This applies equally to any medicalquestionnaire/forms I may complete.I agree to <strong>the</strong> above declarationSignatureNameDateWhere did you see this vacancy advertised? NHS Website Search Eng<strong>in</strong>e O<strong>the</strong>r Website National Newspaper Local Newspaper British Medical Journal Health Service Journal Hospital Doctor Doctor Therapy Weekly Nurs<strong>in</strong>g Times GP Nurs<strong>in</strong>g Standard O<strong>the</strong>r Professional Journal Jobcentre Plus Radio O<strong>the</strong>rStandard_<strong>Application</strong>_<strong>Form</strong>.doc Page 4 of 9

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