Driving License (Card & paper counterpart)
|
|
- Joel Fields
- 5 years ago
- Views:
Transcription
1 VKL Transport Services Ltd Transport & Nursing Agency Unit 210 & 211, Studio 2000, 5 Elstree Way, Borehamwood, Hertfordshire WD6 1SF T: +44 (0) F: +44 (0) E: enquiries@vklnursing.co.uk W: Health Care Assistant Requirements for Membership Requirements Evidence to present at interview Tick Utility Bill (Gas, Electric etc)(less than 2 months old) Proof of Address ID Check Driving License (Card & paper counterpart) Bank Statement Valid Passport / EU ID Card etc. One recent passport photo Eligibility to work in UK Employment Record Written proof of vaccination is required from your Doctor. Non-compliance will result in a delay in work placement. Current Training Certificates. Please supply any / all up to date certificates pertaining to health care and / or mental health care. Including any NVQ certificates. Registration Ask office for which documents you need to submit for CRB. VKL I.D Badge Training *A 5.00 deposit for each on-line course is required at time of registration. Valid Visa / Work Permit NI Card / Official NI letter / P60 or P45 Rubella Varicella Tetanus Tuberculosis Hepatitis B (titre level) Health & Safety* - Fire Safety* - First Aid* Mental Capacity* - Infection Control* Manual Handling* - Medication Administration* Communication (Verbal & Written)* - S.O.V.A* Any Mental Health Awareness Training* Fully completed application form Details of two referees (UK ONLY) CRB payment Updated Yearly (FULL payment required at time of recruitment) I.D Badge payment 5.00 (FULL payment required at time of recruitment) On-Line training Health & Safety, First Aid, Fire Training, Mental Capacity Act, Challenging Behaviour etc Completion of training does not Tutor based Training ~ guarantee registration with VKL. Manual Handling & Mental Health Awareness etc Student letter of acceptance from college. (Student Visa Only) When you have ALL the documents listed above. Call the office on to make an appointment for registration or send application form to office. No one can start work without providing the required documents. I.D. badges will only be processed for successful applicants. See Page 13 See Pages 9 & 10 PLEASE DO NOT COME WITHOUT AN INTERVIEW. 1
2 VKL Transport Services Ltd Transport & Nursing Agency Unit 210 & 211,Studio 2000, 5 Elstree Way, Borehamwood, Hertfordshire WD6 1SF T: +44 (0) F: +44 (0) Application Form for Registration Health Care Assistant Date of application: UK STATUS/VISA British Indefinite leave to remain/permanent Residence Dependant Student Nurse Student Work Permit Holder Asylum Seeker Other Valid from: Valid Until: Ref Number: PERSONAL DETAILS Title: Mr. Mrs. Miss. Ms. First Name: Surname: Date of birth: Marital Status: Married Unmarried Divorced Separated Current address: City: County: Postal Code: Telephone 1: Telephone 2 (mobile): NATIONAL INSURANCE (Card or official NI Letter) National Insurance Number: PASSPORT DETAILS Nationality: Date of Issue: Passport Number: Expiry NEXT OF KIN (IN CASE OF EMERGENCY) Full Name: Title: Mr. Mrs. Miss. Ms. Capacity in which the person is know to you: Address: City: Country: Postal Code: Telephone 1: Telephone 2 (Mobile): Professional References UK based only (Compulsory) REFERENCE 1 (PRESENT/MOST RECENT) REFERENCE 2 Name: Name: Position: Position: Employment Address: Employment Address: Telephone: Telephone: May we approach this referee: Yes/No May we approach this referee: Yes/No 2
3 Employment Details Please give full details of work history for the previous six years, identifying and giving details of any significant breaks. Current / most recent position first.. Continue on separate sheet if required NAME AND ADDRESS OF EMPLOYER POSITION HELD FROM TO SUMMARY OF RESPONSIBILITIES TYPE AND SIZE OF UNIT Education NAME OF SCHOOL COLLEGE UNIVERSITY ATTENDED FULL OR PART TIME FROM TO COURSES TAKEN OR CURRENTLY STUDYING EXAMINATION RESULTS INCLUDING GRADES 3
4 Other Qualifications OTHER QUALIFICATIONS (non-nursing) Qualification: Diploma Degree Masters Higher Date of Qualification(s): Professional Body No.: Date of registration: ENGLISH LANGUAGE IELTS TEST RESULTS (if you have taken IELTS exams please indicate your results below) Listening: Reading: Writing: Speaking: Overall band score: HEALTH CARE COURSES UNDERTAKEN IN ENGLAND: (please provide certificates) Course (please tick if you have attended the following courses) Mental Health Awareness: Control & Restraint: Moving & Handling: Principal of Care Principal of Administration & Control of Medicine: Health & Safety at Work: Infection Control: Food Hygiene: First Aid & CPR: Risk Assessment: Fire Training: Dealing with Vulnerable people and abuse: Alzheimer s: Epilepsy: Other (please specify): Other (please specify): Date of Course Experience Please tick the areas that describe your work experience Experience Less than 6 months More than 6 months 1-2 years 2+ years Experience Less than 6 months More than 6 months 1 2 years 2+ years Nursing Homes Home Care Residential Homes Senior Care Private Homes Catheter Care Hospitals Fluid Charts Schools Urinalysis Community Care NVQ Learning Disability Observations BP/TPR Mental Health Observations Paediatrics NNEB 4
5 Rehabilitation of Offenders Act 1974 England The provisions relating to the non-disclosure of criminal convictions do not apply to certain occupations and activities. The position for which you are applying is one which is exempted under the above order. Therefore it is necessary for you to disclose any criminal convictions, even if, under the Rehabilitation of Offenders Act, they would otherwise be regarded as spent Have you ever been convicted of any criminal offence? Do you have any criminal charges pending? YES / NO YES / NO If you have answered YES to either of the above, please give details: NB. Any information disclosed will be taken into consideration but will not automatically prevent your application from proceeding. However, if you are appointed, failure to disclose any criminal conviction could lead to termination of our ability to act as your agent. Rehabilitation of Offenders Act 1974 England I confirm that the information set out in this form is true and correct, is not misleading and that no material information had been omitted. I understand and agree that if I submit any false or misleading information, this may result in any offer of registration with the agency being withdrawn, or, if already accepted in my dismissal. I hereby authorise VKL Patient Transport Services Ltd to secure all information it may require in connection with my application for registration, Subject to any specific direction I have made related to contacting my referees. I confirm that I have read and understand the conditions of engagement offered by VKL Patient Transport Services Ltd. and agree to be bound by and comply with the same. I have no objection to my details being held on computer records and utilised by the company in pursuit of its legitimate business. I understand that my application is subject to the receipt of satisfactory references, Police clearance and any other checks (where appropriate) including UKBA. I agree to inform VKL Patient Transport Services Ltd of any changes or additions to the information I have supplied. Declaration I declare the information given in this application form is true and complete to the best of my knowledge and belief. I authorise VKL Patient Transport Services Ltd to make any other enquiries to support my application. I agree to respect the confidentiality of patients and clients and any other information I may have access to at all times. Signed. Date 5
6 VKL Transport Services Ltd Transport & Nursing Agency Unit 210 & 211, Studio 2000, 5 Elstree Way, Borehamwood, Hertfordshire WD6 1SF T: +44 (0) F: +44 (0) E: enquiries@vklnursing.co.uk W: Please answer the following questions: Why do you want to work for this company? What kind of experience do you have to work in the Care Industry? How did you get on with your previous manager/supervisor, coworkers and subordinates? How would you describe yourself? What are your strengths and weaknesses? What s your understanding of Confidentiality? THANK YOU FOR COMPLETING THIS FORM 6
7 VKL Transport Services Ltd Transport & Nursing Agency Unit 210 & 211, Studio 2000, 5 Elstree Way, Borehamwood, Hertfordshire WD6 1SF T: +44 (0) F: +44 (0) E: enquiries@vklnursing.co.uk W: IF YOU DO NOT ALREADY HAVE WRITTEN PROOF OF ALL OF THE IMMUNISATIONS LISTED BELOW you are required to consult your GP or practice nurse to complete this form prior to starting work placements with this Agency. It is YOUR responsibility to pay for any charges your GP may make for immunisations. It is very important that you commence your immunizations as soon as possible as it may take several months to fully complete the course. NB. YOU MUST HAVE TB AND RUBELLA SCREENING AND HAVE COMMENCED THE HEPATITUS B COURSE BEFORE YOU WILL BE CONSIDERED FOR WORK. IN ADDITION YOU MUST NOT HANDLE BLOOD AND BODY FLUIDS UNTIL YOU HAVE COMPLETED THE HEPATITIS B COURSE AND HAD A BLOOD TEST TO CHECK FOR HEPATITIS ANTIBODIES. NAME OF APPLICANT: VACCINATIONS DATE BOOSTER DATE HEPATITIS B Varicella GP S OR PRACTICE NURSE NAME (BLOCK CAPITALS) AND SIGNATURE Rubella Tuberculosis Tetanus SCREENING (blood tests) Post vaccination Hepatitis B antibodies Varicella Zoster Virus Antibodies (if not had chicken pox) Rubella Antibodies DATE RESULT GP S OR PRACTICE NURSE NAME (BLOCK CAPITALS) AND SIGNATURE TB screening (heaf / mantoux / tine) Only if no BCG scar. Confirm scar seen. PLEASE SEND COMPLETED FORM WITH YOUR APPLICATION FOR EMPLOYMENT Official Surgery Stamp 7
8 8
9 The following training courses are available to everyone. Compulsory Courses: On Line Training. All Courses are compulsory to those with no previous experience. A Deposit of 5.00 per on-line course is required. Tick the boxes of the courses you would like to complete. COMPLETION OF TRAINING DOES NOT GUARANTEE PLACEMENT WITH VKL. Challenging Behaviour Communicating Effectively Continence Promotion CoSHH (Control of Substances Hazardous to health) Dementia Care Deprivation of Liberties Safeguards Develop as a Worker Diversity & Equality Fire Training First Aid / Basic Life Support Food Hygiene Health & Safety Induction Awareness Infection Control Medication Administration Mental Capacity Moving & Handling Assessment Moving & Handling Theory Palliative Care Person Centered Care Principles of Care Record Keeping Risk Assessment Role of the Care Worker Safeguard of Vulnerable Adults On Line Training Tariff No of Courses Cost per Course Compulsory Tutor based training Manual Handling Practical Minimum 6 people per course Mental Health Awareness Course. Includes Dementia, Challenging Behaviour, Parkinson Disease, Diabetes, Epilepsy and more Minimum 6 people per course Money to be paid before attending the course. Non-Compulsory Tutor based training Physical Intervention. (Control & Restraint) 2 day Course Maximum 8 candidates per course This course is recommended for those working in Mental Health or Patient Transport The above are online training course provided by Social Care TV. Where specified These are complete courses and not short versions. You can do these courses anywhere there is a computer either at home, our office or a cyber café. The certificates for the above courses will be printed out by VKL and issued after full payment is received. COMPLETION OF TRAINING DOES NOT GUARANTEE PLACEMENT WITH VKL. 9
10 Cost Breakdown for SCTV On-Line Training No of Courses Cost per Course No of Courses Cost per Course All prices correct at time of print and may be subject to change without notice. Some courses and course places are subject to availability. Call VKL on for any more information on these courses You may pay directly into the VKL bank account using your name as a reference. HSBC BANK Sort Code: Account Number: PLEASE CALL THE OFFICE WHEN YOU HAVE DONE THIS TO CONFIRM I enclose Cheque / Proof of BACS payment (delete as appropriate) For Signature: Print Name: COMPLETION OF TRAINING DOES NOT GUARANTEE PLACEMENT WITHIN VKL. 10
11 VKL Transport Services Ltd Transport & Nursing Agency Unit 210 & 211, Studio 2000, 5 Elstree Way, Borehamwood, Hertfordshire WD6 1SF T: +44 (0) F: +44 (0) E: enquiries@vklnursing.co.uk W: Equal Opportunity Monitoring Form VKL Transport Services Ltd aims to be an equal opportunity company and selects staff solely on merit irrespective of race, sex, disability etc. In order to monitor the effectiveness of our equal opportunity policy we request all applicants to provide the information indicated below. Completing this form will help to assist the monitoring of our workforce to be representative of the local community and to target any under represented groups. Please Note: Ethnic minority questions are not about nationality, place of birth or citizenship. They are about colour and broad ethnic groups UK citizens can belong to any of the groups indicated. My sex is Male Female Ethnic Origin I would describe my ethnic origin as: British White Irish Any other white background * White and Black Caribbean Mixed White and Black African White and Asian Any other mixed background * Indian Asian or Asian Pakistani British Bangladeshi Any other Asian background * Black or Black British Chinese *Other ethnic group Caribbean African Any other Black background * Chinese Please state: Please tick one box Is there anyone who relies on you for day-to-day care and attention? YES/NO If YES, are they: a) Children b) Other family member or partner Do you consider yourself to have a disability? YES / NO My age is: (please tick appropriate box)
12 12
13 VKL Transport Services Ltd Patient Transport, Nursing Agency Studio 2000, Unit 210 & Elstree Way Borehamwood Hertfordshire WD6 1SF T: +44 (0) F: +44 (0) E: enquiries@vklnursing.co.uk W: Important Notice RE: CRB PRICING & PAYMENT THE TOTAL AMOUNT OF * IS TO BE PAID AT TIME OF REGISTRATION WITHOUT EXCEPTION. You may pay direct into VKL Bank Account using your name as a reference. HSBC BANK - Sort Code: Account Number: PLEASE CALL THE OFFICE WHEN YOU HAVE DONE THIS TO CONFIRM. CRBs ARE NO LONGER TRANSFERABLE BETWEEN AGENCIES YOU WILL HAVE TO APPLY FOR A VKL CRB. All Prices correct at time of print. *Prices are subject to change without notice Public Transport directions to Studio 2000 From Elstree & Borehamwood Railway Station BUS Take the 107 Bus going towards New Barnet/New Barnet Station Departing from Stop A Travel for 6 stops (7 mins) Walk Cross the road so you are on the same side as Cardiff Pinnacle. VKL Patient Transport Services Studio 2000 is the 4 th building on Elstree Way. About 2 mins (0.1 mi) 13
I.D. badges will only be processed when CRB & two references have been submitted to VKL.
Patient Transport Services Ltd Domiciliary & Nursing Care Service Provider T: +44 (0)208 381 6254 F: +44 (0)208 327 0165 T: +44 (0)208 207 3441 M: +44 (0)7932 634 240 E: enquiries@vklnursing.co.uk W: www.vklnursing.co.uk
More informationLONDON HEALTHCARE AGENCY
LONDON HEALTHCARE AGENCY 135 Brockley Rise London SE 23 1NJ. Tel: 020 8291 7171 Fax: 020 8291 7480 Email: info@lhca.co.uk Web: www.lhca.co.uk APPLICATION FORM Personal Details Last Title: Mr / Mrs / Miss
More informationRegistering as a dentist with the General Dental Council (Overseas qualified)
www.gdc-uk.org www.gdc-uk.org Registering as a dentist with the General Dental Council Application Form This application form, accompanying documents and registration fee should be posted to: Registration
More informationRegistering as a dentist with the General Dental Council (EU/EEA/Switzerland)
www.gdc-uk.org Registering as a dentist with the General Dental Council Application Form This application form, accompanying documents and registration fee should be posted to: Registration Team (New Registrations)
More informationRegistering as a dental care professional with the General Dental Council
Registering as a dental care professional with the General Dental Council Application form Please note if your application is incomplete it will be returned to you. Your application form and accompanying
More informationDIPLOMA IN DENTAL HYGIENE AND DENTAL THERAPY APPLICATION FORM FOR ADMISSION IN Jan 2017
DIPLOMA IN DENTAL HYGIENE AND DENTAL THERAPY APPLICATION FORM FOR ADMISSION IN Jan 2017 Please complete clearly in BLACK ink Use the information on the website to ensure that you complete this form correctly
More informationKENYLINK SERVICES LTD.
APPLICATION FORM Post: Care-Assistant Please complete this form fully using black ink or type and return to the above address. THE INFORMATION YOU SUPPLY ON THIS FORM WILL BE TREATED IN CONFIDENCE. PERSONAL
More informationApplication to be restored to the register
Application to be restored to the register (Dentist / Dental Specialist) Please note if your application is incomplete it will be returned to you. Your application form and accompanying documents should
More informationJAK Imaging and Medical Solutions Tel:
Personal Details APPLICATION FORM Title: Mr/Mrs/Miss/Ms: Surname: Forenames: Home telephone: Mobile: Date of birth: Nationality: National Insurance Number: Email: Registered Nurse Pin Number: Name and
More informationEMPLOYMENT APPLICATION FORM
EMPLOYMENT APPLICATION FORM Lethbridge Primary School Lethbridge Road Swindon Wiltshire SN1 4BY Tel: 01793 535033 E-mail: admin@lethbridgeprimary.co.uk Applicant s Name Title of post applied for GUIDANCE
More informationApplication to be restored to the register
Application to be restored to the register (Dental care professional) Please note if your application is incomplete it will be returned to you. Your application form and accompanying documents should be
More informationCall: Visit:
Candidate details are logged on Arithon. Ensure all personal information is completed in the tabs. All candidate documents are to be original sight stamp verified and uploaded per document. All conversations
More informationDELIGHT SUPPORTED LIVING JOB APPLICATION FORM GUIDELINES
DELIGHT SUPPORTED LIVING JOB APPLICATION FORM GUIDELINES Please complete this application form accurately, giving as much details as possible of your skills and experience relating to this job application.
More informationLittle Owls Day Nursery Bank Nursery Assistant Role
Little Owls Day Nursery Bank Nursery Assistant Role Recruitment Pack January 2017 1 Dear Applicant Re: Bank Nursery Assistant Thank you for the interest you have shown in the above role. Please find enclosed
More informationApplication Form Nursing Nurses, Midwives & ODPs
Application Form Nursing Nurses, Midwives & ODPs Please complete in BLOCK CAPITALS Personal Details Mr / Mrs / Miss / Ms Surname First name (as appears on NMC / HCPC register) Other name(s) Maiden name
More informationWelcome to Church Lane Surgery / Dymchurch Surgery
Welcome to Church Lane Surgery / Dymchurch Surgery This form will help us when you attend your first appointment. Please fill in this form to the best of your ability and return to Reception. First names:
More informationDental Hygiene & Dental Therapy. Application Guide For April
School Of Clinical Dentistry Dental Hygiene & Dental Therapy. Application Guide For April 2018. www.sheffield.ac.uk/dentalschool Thank you for your interest in studying Dental Hygiene and Dental Therapy
More informationLittle Owls Day Nursery Nursery Practitioner Role
Little Owls Day Nursery Nursery Practitioner Role Recruitment Pack April 2018 1 Dear Applicant Re: Nursery Practitioner Thank you for the interest you have shown in the above role. Please find enclosed
More informationYour application should arrive by 5pm on the closing date which is Friday 26 th January 2018
Telephone: 01902 341203 Fax: 01902 337302 Email: woodlandsquaker@btconnect.com Web: www.woodlandsquakerhome.org QUAKER HOME & SHELTERED HOUSING FOR OLDER PEOPLE 434 PENN ROAD, PENN WOLVERHAMPTON WV4 4DH
More informationFor tuition prices please contact our school.
For tuition prices please contact our school. FAST TRACK HEALTH CARE EDUCATION APPLICATION INSTRUCTIONS AND CHECKLIST Please fill out the application completely. Then you can print and mail or bring it
More informationApplication checklist
Application checklist Before submitting your application check that all sections of the form have been fully completed and that you have enclosed the following: A full CV A personal statement as described
More informationApplication Form- Cabin Attendant
Application Form- Cabin Attendant PLEASE COMPLETE ALL SECTIONS IN ENGLISH If posting, please attach recent passport photograph Personal Information Title: Full Name: Email: House Number : Street name:
More informationirtec Assessor Award Application Form
irtec Assessor Award Application Form When complete, please forward to: bookings@theimi.org.uk A. Personal Details * indicates mandatory information Title* Surname* Forenames* Date of Birth * Gender *
More informationSocial Work Bursary: Academic Year 2017/18 (For courses starting January 2018 to March 2018) Application notes for students on undergraduate courses
Social Work Bursary: Academic Year 2017/18 (For courses starting January 2018 to March 2018) Application notes for students on undergraduate courses Please note: You must make an application for a Social
More informationMiddlesex University Research Degrees Application Form
Middlesex University Research Degrees Application Form Please complete this application form and return it to research.adm@mdx.ac.uk Section 1: Personal Details Surname / Family Name: Previous Surname:
More informationBicton Heath, Shrewsbury, SY3 8HS
Bicton Heath, Shrewsbury, SY3 8HS Re : Healthcare Assistant (Shrewsbury based) Thank you for your request for further information for the above mentioned post. Please find attached the following : 1. Information
More informationApplication Form. Welsh Government Learning Grant for Further Education 2014/15. student finance wales
student finance wales Welsh Government Learning Grant for Further Education 2014/15 Application Form sound advice on STUDENT FINANCE www.studentfinancewales.co.uk/wglgfe How to complete this application
More informationOCCUPATIONAL HEALTH QUESTIONNAIRE
PLEASE COMPLETE THIS FORM ON YOUR COMPUTER AND SAVE BEFORE PRINTING OCCUPATIONAL HEALTH QUESTIONNAIRE Please ensure you complete the highlighted sections of the Questionnaire (except where indicated as
More informationAPPLICATION FOR INITIAL APPOINTMENT TO THE RQIA LIST OF PART II MEDICAL PRACTITIONERS UNDER THE MENTAL HEALTH (NORTHERN IRELAND) ORDER 1986
APPLICATION FOR INITIAL APPOINTMENT TO THE RQIA LIST OF PART II MEDICAL PRACTITIONERS UNDER THE MENTAL HEALTH (NORTHERN IRELAND) ORDER 1986 Please complete electronically or legibly in block capitals using
More informationWard Clerk - Shrewsbury
Bicton Heath, Shrewsbury, SY3 8HS Re : Ward Clerk - Shrewsbury Please find attached the following documents:- 1. Job Description 2. Information to Candidates 3. Equal Opportunities Monitoring Form 4. Person
More informationApplying to join the pharmacist pre-registration scheme guidance and application form
Applying to join the pharmacist pre-registration scheme guidance and application form Post your form to: Pre-registration New Trainees Customer Services General Pharmaceutical Council 25 Canada Square
More informationRegistration as a pharmacy technician
Registration as a pharmacy technician Send your completed application to: Pharmacy Technician Applications to Register Customer Service Team General Pharmaceutical Council 25 Canada Square London E14 5LQ
More informationPAGE 1 0F 14. G:\MASTER documents to print out\new PATIENT QUESTIONNIRE & Patient Id - ADULT March 2016 ONLINE.doc
PAGE 1 0F 14 Keep this blank page if printing double sided PAGE 2 0F 14 The Surgery Amersham Health Centre Chiltern Avenue, Amersham, Bucks HP6 5AY Tel 01494 434344 : Fax 01494 733711 Dear Patient Thank
More informationFamily doctor services registration Postcode:... To be completed by your doctor
Family doctor services registration GMS1 GSM1 Patient s details Please complete in BLOCK CAPITALS and tick as appropriate Mr Mrs Miss Ms Date of Birth NHS No. Surname Male Female Town and country of birth
More informationWarrior Programme Veteran Assessment & Registration Form
Personal Details Warrior ID Please fill in all the sections of the registration form as missing information will delay our administration procedure. Please ensure that your referring Agency, Mental Health
More informationRecognition as an EEA qualified pharmacist
Recognition as an EEA qualified pharmacist Guidance notes and application form Send your completed application to: EEA Applications General Pharmaceutical Council 25 Canada Square London E14 5LQ Contact
More informationA-Z Hospitals NHS Trust (replace with your employer name)
Department of Health will be issuing new guidance relating to the monitoring of equality in April 2013. The equality and diversity sections within NHS Jobs application forms will be reviewed and updated
More informationOpen University Undergraduate on Study Bursary
Student Fees The Open University PO Box 6055 Milton Keynes MK10 1NH Phone +44 (0)1908 653411 Email: studentfees@open.ac.uk Open University Undergraduate on Study Bursary 2017-18 On Study Bursary Funding
More informationYou must make an application for a Social Work Bursary regardless of whether or not you have been allocated a capped (bursary-funded) place.
Social Work Bursary: Academic Year 2018/19 (For courses starting between 1 September and 31 December 2018) Application notes for students on undergraduate courses Please note: You must make an application
More informationPOLYTECHNICS MAURITIUS LTD
Please complete all sections SECTION ONE: PREAMBLE NATIONAL DIPLOMA IN NURSING APPLICATION FORM You have taken an important step to submit an application for the National Diploma in Nursing at Polytechnics
More informationAPPLICATION FORM. 1. Personal Details. 2. Next of Kin Details. Title: Dr / Mr / Miss / Ms Other: D.O.B: Gender: Male / Female / Other.
6th Floor, Arodene House, 41-55 Perth Road, Ilford, Essex IG2 6BX T: 0208 518 4336 F: 0208 554 8430 E: info@mylocum.com W: www.mylocum.com Reg. No: 05057928 VAT Reg. No: 939486760 APPLICATION FORM 1. Personal
More informationLBR CPD funding 2013/ MENTOR PREPARATION FOR THE HEALTH PROFESSIONS (NMC APPROVED)
Faculty of Health and Wellbeing Staff use only Student Number.. New / Continuing Si updated letter Spreadsheet CPD code LBR CPD funding 2013/2014 - MENTOR PREPARATION FOR THE HEALTH PROFESSIONS (NMC APPROVED)
More informationBRIDGE MEDICAL CENTRE NEW PATIENT REGISTRATION FORM-ADULT
BRIDGE MEDICAL CENTRE NEW PATIENT REGISTRATION FORM-ADULT We only accept patients within our catchment area of Three Bridges, Pound Hill, Worth, Maidenbower, Furnace Green, Tilgate, Northgate, Copthorne
More informationSOUTHWESTERN MICHIGAN COLLEGE NURSING PROGRAM
Office Use Only Date Submitted to Nursing Office SOUTHWESTERN MICHIGAN COLLEGE NURSING PROGRAM Application to Begin the Nursing Program Complete and return to the Nursing Department Electronic signatures
More informationWEST KENT EXTRA LINDA HOGAN COMMUNITY FUND
WEST KENT EXTRA LINDA HOGAN COMMUNITY FUND GRANT APPLICATION FORM 2010 (Please refer to the grant application help with questions pages and the guidance notes) 1. Name of your organisation 2. Name of your
More informationDEADLINE FOR COMPLETION MONDAY 15 th JANUARY 2018
Faculty of Health and Medical Sciences Pre-enrolment Requirements Congratulations on receiving an offer for a place in a Faculty of Health and Medical Sciences course for entry in 2018. There are important
More informationFamily doctor services registration
Family doctor services registration GMS1 Patient s details Mr Mrs Miss Ms of birth Surname First names Please complete in BLOCK CAPITALS and tick as appropriate NHS No. Male Female Home address Previous
More informationNEW PATIENT QUESTIONNAIRE
NEW PATIENT QUESTIONNAIRE Plympton Medical Practice Ivybridge Medical Practice Chaddlewood Medical Practice Wotter Medical Practice The information that we are seeking on this form is to help us offer
More information2014 Diploma in Enrolled Nursing Programme
Faculty of Social and Health Sciences 2014 SUPPLEMENTARY APPLICANT FORMS Documents A to C are to be fully completed, signed and returned to the following address along with verified documents: Student
More informationDISCLOSURE & BARRING SERVICE POLICY AND PROCEDURES
DISCLOSURE & BARRING SERVICE POLICY AND PROCEDURES Updates Who Updated Comments September annually Lewis, Bridget TABLE OF CONTENTS GENERAL PRINCIPLES... 3 TYPES OF DISCLOSURE AND BARRING SERVICE... 4
More informationRECRUITMENT AND VETTING CHECKS POLICY
Trinity School RECRUITMENT AND VETTING CHECKS POLICY All new appointments to Trinity School are subject to recruitment and vetting checks. All members of staff at Trinity School are required, under The
More informationBedford Hospital Occupational Health and Wellbeing Services
Bedford Hospital Occupational Health and Wellbeing Services Please read carefully before completing this document. The purpose of this questionnaire is to ensure you are well enough for the proposed job
More informationNursing Degree Courses ADMISSIONS GUIDE
Nursing Degree Courses ADMISSIONS GUIDE 2018 Student Portal As an offer holder with the University of Gloucestershire you have access to your own Student Portal, where you can upload documents in order
More informationHector Naidoo and Associates Future Leaders Bursary BURSARY APPLICATION FORM
Hector Naidoo and Associates Future Leaders Bursary BURSARY APPLICATION FORM SECTION 1 Dear applicant, We have pleasure enclosing an application form. When completing the form, please take note of the
More informationEmployment Application Form
Version 1.6 Employment Application Form Job Code Ref (NI only): Position Applied For: 1 Title * 2 Forename * 3 Middle (s) 4 Surname * 5 Known As 6a NI Number *UK only 6b PPS *ROI only 7 Date of Birth *dd-mon-yy
More informationFaculty of Health and Wellbeing LBR CPD funding 2012/ MENTOR PREPARATION FOR THE HEALTH PROFESSIONS (NMC APPROVED)
Faculty of Health and Wellbeing LBR CPD funding 2012/2013 - MENTOR PREPARATION FOR THE HEALTH PROFESSIONS (NMC APPROVED) Please indicate the health authority you are applying from Yorkshire and Humber
More informationPlease complete the application form and return it to our office. You may register any time between 9am and 5pm Monday to Friday.
Please complete the application form and return it to our office. You may register any time between 9am and 5pm Monday to Friday. To help us with your application please answer the questions within this
More informationApplication for registration in New Zealand for orthodontic auxiliaries with prescribed qualifications
Application for registration in New Zealand for orthodontic auxiliaries with prescribed qualifications April 2018 This application is to be used by applicants with prescribed qualifications for the orthodontic
More informationApplication for admission to:
Singapore Institute of Management Pte Ltd, SIM Headquarters, 461 Clementi Road, Singapore 599491 Tel: +65 6248 9746 Website: www.simge.edu.sg Application for admission to: Programme Important Instructions
More informationFamily doctor services registration
Family doctor services registration GMS1 Patient s details Please complete in BLOCK CAPITALS and tick as appropriate Mr Mrs Miss Ms Surname Date of birth First names NHS No. Male Female Home address Previous
More informationVOLUNTEER APPLICATION
Thank you for your interest in Estes Park Medical Center. The mission of the Estes Park Medical Center is to make a positive difference in the health and wellbeing of all we serve. VOLUNTEER APPLICATION
More informationDiploma in Enrolled Nursing Application Checklist
T e T a r i M ā t a u r a n g a H a u o r a F a c u l t y o f N u r s i n g a n d H e a l t h S t u d i e s Diploma in Enrolled Nursing Application Checklist Name of Student... Nursing & Health Studies:
More informationEuropean Mutual Recognition application for registration guidance
For help or enquiries: Registration Department, 184 Kennington Park Road, London, SE11 4BU +44 (0)300 500 4472 international@hcpc-uk.org These guidance notes will help you to complete the European Mutual
More informationPage 1 of 6
Daphne Cockwell School of Nursing - Post Diploma Degree Program Practice Requirements Record (PRR) Spring 2019 term: DUE February 15, 2019 Fall 2019 & Winter 2020 term: DUE May 24, 2019 Practice Requirements
More informationIRB STRENGTH & CONDITIONING LEVEL 1 APPLICATION FORM 2014/15 Season
PREREQUISITE REQUIREMENTS ALL candidates MUST have complete the following prior to attending a IRB Strength & Conditioning course; Date completed: IRB On-Line RugbyReady selfassessment (available on Date
More informationApplication for restoration to the New Zealand medical register
Application for restoration to the New Zealand medical register REG6 August 2017 Registration. PO Box 10 509, The Terrace, Wellington, 6143, New Zealand Level 28 Plimmer Towers Wellington, 6011, New Zealand
More informationBicton Heath, Shrewsbury, SY3 8HS
Bicton Heath, Shrewsbury, SY3 8HS Re : Hospice at Home Healthcare Assistant Please find attached the following documents:- 1. Job Description 2. Person Specification 3. Information to Candidates 4. Equal
More informationTRUSTS / PRIVATE ORGANISATION - PLEASE COMPLETE:
STAFF USE ONLY Faculty of Health and Wellbeing Student Number New/Continuing SI updated letter Spreadsheet CPD code LBR CPD funding 2013/2014 - PRACTICE TEACHER PREPARATION Please indicate the Health Authority
More informationForm 18. APPLICATION FOR RESTORATION OF NAME TO THE REGISTER IN TERMS OF SECTION 19(5) OF THE HEALTH PROFESSIONS ACT, 1974 (ACT No.
Form 18 APPLICATION FOR RESTORATION OF NAME TO THE REGISTER IN TERMS OF SECTION 19(5) OF THE HEALTH PROFESSIONS ACT, 1974 (ACT No. 56 OF 1974) NON COMPLIANT APPLICATION WILL BE REJECTED AND SENT BACK TO
More informationPOST-GRADUATE CERTIFICATE IN THE THEORY OF ACCOUNTING (CTA) APPLICATION FORM 2016
POST-GRADUATE CERTIFICATE IN THE THEORY OF ACCOUNTING (CTA) APPLICATION FORM 2016 BEFORE YOU START COMPLETING THEIS FORM PLEASE READ AND SIGN THE FOLLOWING CONSENT TO COLLECT PERSONAL INFORMATION. I accept,
More informationUniversity of Aberdeen. Notes for Postgraduate Applicants
University of Aberdeen Notes for Postgraduate Applicants These Notes will assist you in completing an Application Form for Postgraduate Taught Programmes, or In-Service (Education) study. IMPORTANT NOTES
More informationGraduate Diploma In Mental Health (GDMH) Intake
Graduate Diploma In Mental Health (GDMH) Intake 2017-2018 Please tick the appropriate boxes accordingly. * Delete where applicable APPLICATION FORM (A) PERSONAL PARTICULARS Name (as in NRIC/Passport):
More informationAPPLICATION FOR ASSESSMENT AS A MEDICAL PHYSICIST FOR MIGRATION PURPOSES
OFFICE USE ONLY APPLICATION NUMBER: DATE RECEIVED: APPLICATION FOR ASSESSMENT AS A MEDICAL PHYSICIST FOR MIGRATION PURPOSES Notice to Applicants The Australasian College of Physical Scientists and Engineers
More informationP: W: E: APPLICATION FORM FOR POSITION OF. English Teacher
PO Box 64437, Botany, Auckland 2163 P: 09 274 4086 W: www.sanctamaria.school.nz E: admin@sanctamaria.school.nz APPLICATION FORM FOR POSITION OF English Teacher Please complete all details and send with
More informationNHS RESEARCH PASSPORT POLICY AND PROCEDURE
LEEDS BECKETT UNIVERSITY NHS RESEARCH PASSPORT POLICY AND PROCEDURE www.leedsbeckett.ac.uk/staff 1. Introduction This policy aims to clarify the circumstances in which an NHS Honorary Research Contract
More informationOverseas Pharmacists Assessment Programme (OSPAP)
Overseas Pharmacists Assessment Programme (OSPAP) Application and Guidance notes Send your completed application to: International Applications General Pharmaceutical Council 25 Canada Square LONDON E14
More informationTHE UPWELL HEALTH CENTRE Townley Close. Upwell. Wisbech. Cambs. PE14 9BT
THE UPWELL HEALTH CENTRE Townley Close. Upwell. Wisbech. Cambs. PE14 9BT Dr P.R. Williams Dr E.J. Clarke Dr A.C. Blundell Dr J. A. Haine Dr V Bhardwaj 2612133 3055285 3679188 6075423 5205875 Practice &
More informationBooklet which will provide you with all important information about our practice.
HARBOUR VIEW HEALTHCARE Shoreham Health Centre, Pond Road Shoreham-by-Sea, West Sussex.BN43 5US Telephone 01273 466044/01273 466052 3 Downsway Southwick, West Sussex. BN42 4WA Telephone 01273 592764 www.harbourviewhealthcare.com
More informationFamily doctor services registration
Family doctor services registration GMS1 Patient s details Please complete in BLOCK CAPITALS and tick as appropriate Mr Mrs Miss Ms Surname Date of birth First names NHS No. Male Female Home address Previous
More informationApplication for admission to: (Important: Tick accordingly and fill in the year of intake)
Singapore Institute of Management Pte Ltd, SIM Headquarters, 461 Clementi Road, Singapore 599491 Tel: +65 6248 9746 Website: www.simge.edu.sg Application for admission to: (Important: Tick accordingly
More informationCROYDON PARTNERSHIP Youth Opportunity Community Grants
CROYDON PARTNERSHIP Youth Opportunity Community Grants 1. ALL ABOUT YOU 1.1. Please provide the contact details of someone we can speak to if we have any queries about your application. They should be
More informationNon-routine Medicine Funding Request (NMFR) Form Effective September 2017
Non-routine Medicine Funding Request (NMFR) Form Effective September 2017 This form should be completed by a patient or patient representative in circumstances where a patient wishes to receive a medicine
More informationArts Council of Northern Ireland Support for the Individual Artist Programme Application Form
Arts Council of Northern Ireland Support for the Individual Artist Programme Application Form Please read the guidance notes carefully before completing this application form. SCHEME Travel Awards Rolling
More informationGraduate Paramedic Internship
Graduate Paramedic Internship 1 Ambulance more First Aid for all Territorians Table of contents Introduction The Ambulance Service What it means to be a Paramedic The Selection Process Application flow
More informationDivision of Community Education Application for Certified Nursing Assistant Program CNA APPLICATION CHECK LIST
CNA APPLICATION CHECK LIST Applicant Name: Phone No: Alternative No: Application Date: Please submit this information to WCCC as soon as possible. You will not be eligible to start classes if we do not
More informationVOLUNTEER APPLICATION
Please return to: Mount Nittany Medical Center Volunteer Services Department 1800 East Park Avenue State College, PA 16803 814.234.6170 VOLUNTEER APPLICATION Application Date Assignment Interview Date!
More informationApplication for registration within a vocational scope of practice
Application for registration within a vocational scope of practice VOC3 Aug 2017 For doctors who hold a postgraduate medical qualification which is not the prescribed New Zealand or Australasian postgraduate
More informationPart 1 Elective Application Form
Part 1 Elective Application Form Please read Information about Elective Placements before completing this form. All parts of the form must be completed. Please submit to Peninsula Clinical School, Level
More informationAn advert will be posted in the relevant newspaper advertising the job vacancy for approximately 2 weeks.
Safer Recruitment Policy Little Acorns Nursery is committed to providing the best possible care to its children and to safeguarding and promoting welfare of young children. The nursery is also committed
More informationApplication for registration in New Zealand Part B: This form is to be accompanied by Part A [checklist] and all documents required on checklist
Application for registration in New Zealand Part B: This form is to be accompanied by Part A [checklist] and all documents required on checklist REG1 August 2017 For office use only Registration no: PO
More informationIRISH AID IRISH AID IDEAS PROGRAMME: STRAND II
IRISH AID The government of Ireland s official programme of assistance to developing countries is managed by Irish Aid, a division within the Department of Foreign Affairs and Trade. The aid programme
More informationLEICESTER INTERNATIONAL PATHWAY COLLEGE APPLICATION FORM
LEICESTER INTERNATIONAL PATHWAY COLLEGE APPLICATION FORM Please complete ALL sections of the following form clearly and accurately using CAPITAL LETTERS. If information is missing from your form, or we
More informationApplication Guidelines Postgraduate Diploma Midwifery (90-week shortened programme)
Application Guidelines 2017-18 Postgraduate Diploma Midwifery (90-week shortened programme) Overview March 2017 entry Page 1 of 12 Application Guidelines March 2017 Eligibility Thank you for your interest
More informationProfessional Indemnity and Legal Defence Insurance
Professional Indemnity and Legal Defence Insurance for Locum, Hospital, Primary Care Pharmacist, Pharmacy Technician, Pre Registration Trainee/Student Pharmacist and Dispensary Assistant Application Form
More informationPART 1 ELECTIVE APPLICATION FORM
PART 1 ELECTIVE APPLICATION FM Please read Information about Elective Placements before completing this form. All parts of the form must be completed. Please submit to, Level 3, Hastings Rd Frankston Vic
More informationPlease select the scope of practice and any additional scopes of practice which you are seeking registration in.
Assessment of eligibility for registration in New Zealand for holders of non-prescribed qualifications seeking individual assessment under s.15(2) of the Health Practitioners Competence Assurance Act 2003
More informationARTS COUNCIL OF NORTHERN IRELAND MUSICAL INSTRUMENTS FOR BANDS SAMPLE APPLICATION FORM
ARTS COUNCIL OF NORTHERN IRELAND MUSICAL INSTRUMENTS FOR BANDS SAMPLE APPLICATION FORM Deadline for Applications: 4pm Thursday, 5 October 2017 Decisions: by 30 November 2017 PLEASE READ THE GUIDANCE NOTES
More informationSOUTH AFRICAN COUNCIL FOR PLANNERS SACPLAN BURSARY FOR PLANNING STUDENTS CALL FOR APPLICATIONS
SOUTH AFRICAN COUNCIL FOR PLANNERS SACPLAN BURSARY FOR PLANNING STUDENTS CALL FOR APPLICATIONS 2017 1 SACPLAN BURSARY FOR PLANNING STUDENTS CALL FOR APPLICATIONS - 2017 The South African Council for Planners
More informationMANAGER S CERTIFICATE OR RENEWAL OF MANAGER S CERTIFICATE
MANAGER S CERTIFICATE OR RENEWAL OF MANAGER S CERTIFICATE Sections 219 or Section 224, Sale and Supply of Alcohol Act 2012 Receipt Number: You must apply to renew your Manager s Certificate on or before
More information