Cranfield and Marston Surgery

Application for employment

Post applied for: / Receptionist
Where did you see the post advertised? / - Select -NHS JobsJobs NowBeds on SundayMK NewsSurgery websiteOther

About you

Surname / Title
First names
Address
Postcode
Telephone No Home
Mobile
E-mail address
Are you legally eligible for employment in the UK?
Do you require a work permit to work in the UK?
Please note that prior to making an offer of employment, we are required by law to verify documentary evidence (and maintain copies for our files) regarding a candidate’s eligibility to work in the UK. This applies to all applicants regardless of nationality/origin.
Have you any criminal convictions which are not ‘spent’?
This post is exempt from the provisions of the Rehabilitation of Offenders Act 1974, which means that applicants are not entitled to withhold any information requested about previous convictions even if, in other circumstances, they would be regarded as ‘spent’ under the Act.
If yes please give dates and details

Current or most recent employment or work experience

Title of Post
Number of Hours worked per week
Address
Postcode
Nature of Business / Date started
Salary and Hourly Rate / Period of Notice
Summary of Duties Responsibilities
Reason for leaving

Education and qualifications

School, college, University or other organisation

/

From

MMMM YYYY /

To

MMMM YYYY /

Qualification, subject and achievement

Information in support of this application

In your own words, describe why you would be a good applicant for this post, including experience you have gained, skills you have to offer and personal qualities.

Please continue on a separate sheet as necessary

Previous employment

Employer

/

Position

/

From

/

To

/

Reason for leaving

Please continue on a separate sheet as necessary

References

Please give the name, address and telephone number of two people who would be willing to give you a reference. If you are currently or have recently been in employment, one of these should be your current or last employer. If not, a referee should be a person who can make a statement with regard to your character, e.g. a school or college teacher. Referees must not be members of your family or related to you in any way.

Name

Job title

Address

Telephone

How does this person know you?

May we take up this reference before offering you the post?

Name

Job title

Address

Telephone

How does this person know you?

May we take up this reference before offering you the post?

Declaration

The information in this section 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 understand that Cranfield and Marston Surgery is permitted to hold personal information about me as identified on this application form as part of its recruitment procedures and personnel records.

Note: Cranfield and Marston Surgery is an equal opportunities employer and does not unlawfully discriminate in employment. No information provided by the applicant will be used for the purpose of limiting or excluding any applicant from consideration for employment on a basis prohibited by law.

I agree to the above declaration

/

Date:

Submitting your application

Please ensure that you have completed all of the form as accurately as you can. If you have used additional sheets, please ensure that they clearly state your name, the post applied for and the section that they relate to. Please return the equal opportunities monitoring form in the same envelope or email.

You can return your form and supporting information by post:
Recruitment
Cranfield Surgery
137 High Street
Cranfield
BedfordMK43 0HZ
By email:
In person at either Cranfield Surgery or Marston Surgery

Author:Andrew Boyd
File:T:\Practice Manager\Staff\Recruitment Folder\FPM Useful Documents\CMS application form post.doc.docx
Date:13/12/2013Version:1.8

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