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Independent private hospital, Banbury, Oxfordshire
Call us on 01295 252281
Sign up to the mailing list
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Start your application here
Position applied for
Personal details
Mr
Mrs
Miss
Ms
Dr
Prof.
Rev.
Other
Title
Forename
Surname
Home Telephone No:
Mobile Telephone No:
Work Telephone No:
(if it may be used)
Address:
Street Address
Address Line 2
City
State
Postal/Zip Code
Do you have the right to work in the UK?
Yes
No
Please note that any offer of employment will be conditional upon your supplying evidence of your right to work in the UK.
e-mail address:
National Insurance No:
Please indicate how you would prefer us to communicate with you:
Phone
e-mail
Post
How did you hear about this vacancy?
Nursing Press
Local Press
Social Media
Informal Visit
Other website
General Enquiry
From an existing employee
Recruitment Drive
Company website
Other
If Other, please specify in the box below
Please specify
Education and training
Academic and other relevant qualifications
Qualification One
Dates
(From - To)
School/College/University/Other name
Qualifications Obtained
(Grade/Date)
Qualification Two
Dates
(From - To)
School/College/University/Other name
Qualifications Obtained
(Grade/Date)
Qualification Three
Dates
(From - To)
School/College/University/Other name
Qualifications Obtained
(Grade/Date)
Qualification Four
Dates
(From - To)
School/College/University/Other name
Qualifications Obtained
(Grade/Date)
Membership of professional bodies
Membership Details One
Awarding Body
Membership Joining Date
Professional Registration Number
(eg NMC/HCPC)
Expiry Date
Membership Details Two
Awarding Body
Membership Joining Date
Professional Registration Number
(eg NMC/HCPC)
Expiry Date
Training courses attended
(including short courses and workplace training)
Training Course One
Dates
(From - To)
Course Title
Organising Body
Result
(Grade/Date)
Training Course Two
Dates
(From - To)
Course Title
Organising Body
Result
(Grade/Date)
Training Course Three
Dates
(From - To)
Course Title
Organising Body
Result
(Grade/Date)
Current employment
Name of Current Employer
Position Held
Address of Current Employer
Street Address
Address Line 2
City
State
Postal/Zip Code
Salary
Length of time in post
Grade (if applicable)
Period of notice required
Enhancements/other Benefits
(Please list below)
Number of days sickness in last 12 months
Brief description of current duties and responsibilities:
Employment history
Please list below full details of any other employment over the last ten years beginning with your most recent employment.
Previous Employment One
Dates
(From - To)
Job Title
(including grade if NHS)
Name/Address of employer and nature of business
Salary
(Upon Departure)
Reason for Leaving
Add another?
Yes
Previous Employment Two
Dates
(From - To)
Job Title
(including grade if NHS)
Name/Address of employer and nature of business
Salary
(Upon Departure)
Reason for Leaving
Add another?
Yes
Previous Employment Three
Dates
(From - To)
Job Title
(including grade if NHS)
Name/Address of employer and nature of business
Salary
(Upon Departure)
Reason for Leaving
Reason for application
Please use this space to say why you are applying for this position and to give any additional information in support of your application. Continue on a separate sheet if necessary.
References
Upload CV in support of your application (optional):
Accepted file types: jpg, pdf, docx, Max. file size: 10 MB.
Reference One
Contact Name:
Mr
Mrs
Miss
Ms
Dr
Prof.
Rev.
Title
Forename
Surname
Company Name:
Address:
Street Address
Address Line 2
City
State
Postal/Zip Code
Telephone No/Extn:
e-mail address:
Job Title:
Relationship to you:
May we contact this referee BEFORE interview?
Yes
No
Reference Two
Contact Name:
Mr
Mrs
Miss
Ms
Dr
Prof.
Rev.
Title
Forename
Surname
Company Name:
Address:
Street Address
Address Line 2
City
State
Postal/Zip Code
Telephone No/Extn:
e-mail address:
Job Title:
Relationship to you:
May we contact this referee BEFORE interview?
Yes
No
Please provide details if you were known by a different name:
When would you NOT be available for interview?
THE REHABILITION OF OFFENDERS SECTION BELOW MUST BE COMPLETED BY ALL APPLICANTS
Rehabilitation of Offenders Act (exceptions) orders 1975 - England and Wales
Rehabilitation of Offenders Act 1974(Exclusions and Exceptions)(Scotland) order 2003 (as amended)
Applicants are therefore, not entitled to withhold information about convictions which for other purposes are spent under the provisions of the Act. In the event that you are employed, any failure to disclose such convictions could result in disciplinary action or dismissal. Any information given will be completely confidential and will be considered only relation to an application for positions to which the order applies.
Do you have any criminal convictions?
*
Yes
No
If YES, you must give details of all convictions below.
Details of convictions:
Data Protection Act 1998
I consent to Foscote Hospital processing personal data about me for purposes related to my employment in line with the Data Protection Act, 1998.
I understand that an appointment, if offered, is subject to the information I have given on this form being true and correct and that any offer of employment is subject to a satisfactory health report. I understand that withholding or mis-stating any of the facts called for above may result in the refusal or termination of my employment.
I declare that the information given on this application form is true and correct to the best of my knowledge.
Signature:
Date:
MM slash DD slash YYYY
Applications for advertised roles and speculative applications
If you are applying for a recently advertised position your application will automatically be forwarded to the relevant hiring manager. If you do not hear from us within 2 weeks of the closing date you should assume that your application has not been successful on this occasion. We will hold your details on file for a period of up to six months should a suitable position become available.
If you do not want us to hold your details on file please tick here
If you are applying for a recently advertised position your application will automatically be forwarded to the relevant hiring manager. If you do not hear from us within 2 weeks of the closing date you should assume that your application has not been successful on this occasion. We will hold your details on file for a period of up to six months should a suitable position become available.
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