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Open Day Application Form 11.11.17

This document is a short application form for a job with Plymouth Hospitals NHS Trust. It requests basic personal details like name and contact information. It also asks for education and professional qualifications, employment history including previous NHS work, and references. The final sections request a supporting statement on why the applicant is suitable for the role and how they heard about the job vacancy. The applicant must agree to a declaration that the information provided is true before submitting.

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29 views

Open Day Application Form 11.11.17

This document is a short application form for a job with Plymouth Hospitals NHS Trust. It requests basic personal details like name and contact information. It also asks for education and professional qualifications, employment history including previous NHS work, and references. The final sections request a supporting statement on why the applicant is suitable for the role and how they heard about the job vacancy. The applicant must agree to a declaration that the information provided is true before submitting.

Uploaded by

bsebi763271
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
You are on page 1/ 2

www.jobs.nhs.

uk
____________________________________________________________________________
NHS SHORT APPLICATION FORM
APPLICATION FOR EMPLOYMENT WITH Plymouth Hospitals NHS Trust
Job Reference Number PHNTOPENDAY 11.11.2017
Job Title
Department
Please state area of
interest or speciality
Personal Details
Title
*Surname/Family Name

*First Name
Name in which you are registered
with a professional body (if
applicable)
UK National Insurance No

Address

*Postcode/ Zip code


Mobile Telephone
(only if UK registered)
Email Address
*Are you a United Kingdom (UK), European Community (EC) or European Economic Area
(EEA) National?
 Yes  No

Education & Professional Qualifications


Please provide all relevant training and qualifications, also indicate subjects currently being
studied and expected year of qualification. All qualifications disclosed will be subject to a
satisfactory check.
Are you PIN registered?  Yes  No

If yes, please state your PIN Number…………………………………….

Employment History
Please record below the details of your latest employment history.
Have you ever worked for the NHS?  Yes  No
Employer Name

Employer Address

Your Job Title


Start Date (MM/YYYY) End Date (MM/YYYY)

384834466.doc Confidential Page 1 of 2


www.jobs.nhs.uk
____________________________________________________________________________
Reason for leaving (if applicable)

Description of your duties and responsibilities

Referee 1
* Type of Reference  Employer  Educational  Personal
Title
*Surname/Family name * First Name
*Relationship
Employer Name
Telephone Email

Supporting Information
In this section please give your reasons for applying for this post and additional information which demonstrates
how you match the person specification.
* Supporting information

Where did you hear about the event? Please highlight accordingly
NHS Jobs Radio
Facebook Newspaper
Twitter Other – Please state…………………………………….

Declaration
The information in this form is true and complete. I agree that any deliberate omission, falsification or misrepresentation in the application form
will be grounds for rejecting this application or subsequent dismissal if employed by the organisation. Where applicable, I consent that the
organisation can seek clarification regarding professional registration details.

I agree to the above declaration


Signature

Name Date

384834466.doc Confidential Page 2 of 2

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