FAVERSHAM MEDICAL PRACTICE

APPLICATION FORM

NOTE: Please complete carefully by hand in blue pen

POST DETAILS:
Position applied for: / Where did you hear about this vacancy? / Have you worked with Faversham Medical Practice before?
YES / NO
Salary Expected: / Do you have any unspent criminal convictions? If yes please give details.
YES / NO / Are you looking for full time or part time work?
FULL TIME / PART TIME
If part time, state the days and hours you wish to work: / If ‘YES’ please give details:- / If offered this position, would you continue to work in any other capacity?
YES / NO
PERSONAL DETAILS:
Surname: / Forename: / National Insurance No:
Address and postcode: / Telephone (mobile):
Telephone (home):
Email address:
Do you hold a current driving licence:
YES / NO
Are you legally eligible for employment in the UK?
YES / NO / Do you require a work permit to work in the UK?
YES / NO
EDUCATION, QUALIFICATIONS & TRAINING
Beginning with the most recent events, give details of your education, qualifications and training to date.
School, College or University / Dates: / Qualifications gained: / Grade:
From: / To:
PRESENT AND PAST EMPLOYMENT (1)
Name and address of employer:
Position held: / Date commenced employment:
End date of employment:
Reason for leaving:
Salary:
PRESENT AND PAST EMPLOYMENT (2)
Name and address of employer:
Position held: / Date commenced employment:
End date of employment:
Reason for leaving:
Salary:
PRESENT AND PAST EMPLOYMENT (3)
Name and address of employer:
Position held: / Date commenced employment:
End date of employment:
Reason for leaving:
Salary:
FURTHER INFORMATION
PERSONAL ATTRIBUTES
Why you think you would make a good addition to the Faversham Medical Practice team?
REFERENCES
Please provide names, addresses and occupations of two referees (not relatives), (preferably previous employer) who you give permission for Faversham Medical Practice to approach with regard to your application.
  1. Name and address of referee:
/
  1. Name and address of referee:

Phone number: / Phone number:
Email address: / Email address:
Occupation: / Occupation:
DECLARATION
I declare that to the best of my knowledge and belief, the information given in this application is correct:
Signature: ……………………………………………… Date:……………………………………..
FOR OFFICE USE ONLY
Application evaluation comments:
Name: Date:
Actions
1ST stage INTERVIEW / Date: / REJECT OR HOLD
2nd stage INTERVIEW (IF REQUIRED) / Date: / REJECT OR HOLD
3rd stage JOB OFFER / Date: / REJECT OR HOLD

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