APPLICATION FORM
Please complete all sections of this form in full in type details. Incomplete applications will not be forwarded for shortlisting. You must return your completed application by the closing date by email to theabove address. Applications received after the closing date will not be accepted. Please do not include a Curriculum Vitaes (CVs) as these will not be used in the recruitment selection process. All applicationswill be treated in confidence.
SECTION One:Details of Post Applied for / Office Use Only
Please record below the title and reference number of the Post your are applying for
Job Title) / Modern Apprentice - Dental Health Support Worker
Job Ref No:
/ Candidate Identification number
(office use only):
Date application received (office use only)
No applicant will be unfairly discriminated against. We are particularly alert to eliminating discrimination on account of age, cultural/religious/political belief, disability,ethnicity,gender, race, relationship status, sexual orientation, and/or Trade Union membership or stewardship. Please note the information you provide in Section One, Personal Details, and Section Six, Equal Opportunities Monitoring, of this form will NOT be used for shortlisting.
PERSONAL DETAILS :
Surname / Forename(s)
Title (Mr, Mrs, Miss, Ms, Other) / I am years old. My date of Birth is //
Current Address
Postcode
Telephone Number Home / Telephone Number
Mobile
Telephone Number
Work (if applicable) / Email address
Please ensure you check your email account regularly as we will update you on the progress of each stage of the recruitment process via email, text and letter.
(Continue on next page)1
SECTION Two Education and Qualifications :Please provide details of your education and qualificationsobtained, starting with your most recent first. You will be required to provide proofof qualifications if selected for interview. If you have had a break in youreducational history please give details. Continue on theAdditional Information sheet attached to this Application Form if you require additional details.Please check that your qualifications meet the minimum qualification level please refer to the Candidate Information Pack for details. We areunable toaccept applications for candidates who do not meet the minimum qualifications criteria for the post(s).
EDUCATION HISTORY (SCHOOL/COLLEGE ETC)School/College Name and Full Postal Address / Date started (mm/yy) / Date finished (mm/yy)
h
If applicable, detail of any breaks in educational history:
Date left school (mm/yy)
examinationpasses /QUALIFICATIONS
National/Standard Grades
Subject/Module
(please state National or Standard Grade) / Level Awarded / Year obtained / Higher/ Intermediate 1 or 2 Subject/Module
(please state Higher or Intermediate 1/2) / Level Awarded / Year obtained
Additional/ Equivalent examination passes/ Qualifications
(e.g. GCSEs/a-levels National Certificate Modules/ other)
Qualification Type / Subject/Module / Year obtained / Grade/Mark Awarded
Please give details of any additional qualifications/ training completed.
MOST RECENT WORK EXPERIENCE (INCLUDING PART TIME AND VOLUNTARY WORK)
Employer / Dates
From To / Job title and main duties
(Continue on next page)1
SECTION THREE FURTHER INFORMATION IN SUPPORT OF YOUR APPLICATION:Please ensure you carefully respond to all of the questions in this section as the information you provide will be used to support your application as part of the recruitment selection process.Where possible, give examples to support the information which you are providing. Please note an important aspect of the selection process will be the applicant’s match to the essential and desirable requirements as outlined in the Person Specification for each of the Modern Apprenticeship vacancies
1. WHY are you interested in Working andtraining for A MODERNAPPRENTICESHIP WITH nhs greater glasgowandCLYDE? PLEASE DESCRIBE briefly why you think you would be a SUITABLE PERSON to work in a health care ENVIRONMENT.2. Please provide an example of when you have had AN INVOLVEMENT IN being part of a TEAM, what was your involvement or role and what contribution did you make to the TEAM. Tell us briefly how you felt about the contributions of other members of the team
3. Please tell us about any additional skills you have developed through leisure or other interests such AS VOLUNTARYWORK,workEXPERieNCE PLACEMENTSor any positions of responsibility you currently hold or have held in the past . Tell us briefly how you think these skills might be useful in selEcting you for A MODERN APRENTICESHIP.
4. final comments to support your application (MAX 250 WORDS)
please use this section to summarise or highlight any additional information you would like to tell us about e.g your personal qualities, qualifications ,skills or achievements
(Continue on next page)1
section Four referees:Please provide details of two referees who may be contacted for references.Where possible these should be from your most recentschool/education establishment or your current or most recent employer. A character reference will be accepted however please note we do not accept family members or friends as referees.
As referees are contacted by email please ensure you check to ensure the email detail iscorrect. Note that references will only be taken up for preferred candidates following interview. Our pre-employment screening also includesHealth and Fitness for Work, Membership of Disclosure Scotland PVG Scheme/Disclosure Scotland Check,Verification of Examination Results/Qualifications and Right to Work in the UK.
REFEREE 1:type of referee academic work character otherName / Job Title/position
address / EMAIL
postcode / Telephone no
REFEREE 2: type of referee academic work character other
Name / Job Title/position
address / EMAIL
postcode / Telephone no
Where did you first see this post?
School
Skills for Scotland Live event at SECC (October 2014)
NHS Greater Glasgow and Clyde Website
NHS Greater Glasgow and ClydeVacancy Bulletin
SHOW - ( )
Job Centre Plus
Other (please specify)
Additional Information Sheet:
Please use this sheet if you require additional space for information.
(Continue on next page)1
sECTION Five Declarations :(i) Disability
The Disability Discrimination Act 1995 (DDA) defines Disability as follows “any physical or mental impairment which has a substantial adverse effect on a person’s ability to carry out normal day to day activities”. NHS Scotland is “Positive about Disabled People” as part of our continued commitment to extend job opportunities for people who are disabled. NHS Scotland operates a Job Interview Guarantee (JIG). Candidates who indicate they have a disability and meet the minimum criteria outlined within the person specificationwill be guaranteed an interview. However, some disabled people prefer not to take this option so please tick your preference if you are a disabled candidate.
Do you want to participate in the interview guarantee scheme? (Please mark an x in the appropriate box)
YES NO
Please specify any special requirements you require if attending for interview
(e.g. Induction Loop, Wheelchair Access, Signer):
(ii) asylum and immigration act 1997
NHS Greater Glasgow and Clyde has a legal obligation to ensure that it does not employ any worker who does not have the right to work in the UK. We are required to check the entitlement to work in the UK of all prospective employees, regardless of nationality or job category. If you are successful in obtaining employment within NHS Greater Glasgow and Clyde you will be required to provide evidence of your entitlement to work in the United Kingdom.
(iiI)WORKING IN THE UK: The reason for these questions is our need to determine whether permission to work in the UK is required. Please mark an x in the appropriate box.
Do you hold a British or European Economic Area passport? (If your answer is yes, you do not need to answer the following question) / YES / NO
Do you require a work permit to work in the UK? / YES / NO
(iIii) REHABILITATION OF OFFENDERS ACT 1974
Criminal Convictions/Cautions
The Rehabilitation of Offenders Act 1974, provides for many people who have been convicted of/cautioned over certain criminal offences the opportunity to have no need to refer to these convictions/cautions or the circumstances relating to them in the course of their daily lives. Certain convictions/cautions can, therefore, be regarded as “spent” after the lapse of a period of years under the terms of the Act. The National Health Service employment for which you are applying is excluded in the provisions of the Act unless otherwise stated in the job description. Unless stated, you are required not to withhold information about convictions/cautions which for other purposes are “spent” under the provisions of the Act. This means that all previous convictions/cautions must be declared. If you are offered employment, any failure to disclose such convictions/cautions could result in dismissal or disciplinary action. Any information given, however, will be completely confidential and will be considered only in relation to the post for which this application form refers. Information will be verified by Disclosure Scotland for relevant posts. (Please mark the appropriate box with an x)
I declare that I have: (a) No previous convictions/Cautions (b) Previous convictions/Cautions
Details of previous convictions/Cautions:
Please note you will be required to sign the declaration on page 7 of this application form after completion of this section.
(v) Declaration
Please read the following points and sign below when you have completed your form
- I have completed this application form and the details I have supplied are, to the best of my knowledge, true and complete and I have not withheld any relevant information
- I understand that if appointed to this post the information on this form will be kept as part of my Employee Record File
- I authorise you to obtain references to support this application if I am identified as a preferred candidate
- I understand that details of examination passes/qualifications will be verified
- I understand that if I have made any false statements or omitted any information, I am liable to have my application rejected, or if appointed, liable to disciplinary action which may result in dismissal on the grounds of dishonesty.
- I consent to details being retained confidentially and used for specific and lawful purposes as specified in the Data Protection Act 1998
/ Date:
Print name:
As you are completing this form electronically you can type your name in the space provided for your signature. If you are unable to return your application form by email then please complete using black ink in block capitals, sign and date it and return by the closing date to : NHS Greater Glasgow and Clyde , Recruitment Service , Modern Apprenticeships, The Modular Building, Gartnavel Royal Hospital , 1055 Greater Western Road Glasgow G 12 OXH. Please mark the job reference number(s) for the post(s) your are applying for on the front of your envelope .
Please now complete Section Six, Equal Opportunities Monitoring.
(Continue on next page)1
SECTION Six Equal Opportunities Monitoring Form:Candidates name :
Equal Opportunities Monitoring
We want to ensure that our job opportunities are open to all. The only way we can ensure there is equal opportunity is to monitor applications we receive and compare the profile of people who apply with those appointed. Therefore this form asks you for your ethnic origin, gender, disability, religion, sexuality and age. The information you provide in this part of the form is confidential and is not used in the selection process. It will be separated from the rest of the form when we receive it.
1)If you are currently an employee of this NHS Board, will getting this job be a promotion?
Yes / No
2)You are:
Female / Male
3)Have you undergone, are you undergoing or do you intend to undergo gender reassignment? For example, this includes having changed your sex (gender)?
Yes / No / Prefer not to say
4)What is your age?
I am years old, and my date of birth is:
5)Do you have a physical or mental health condition or disability that:
- has a substantial effect on your ability to carry out day to day activities?
- has lasted or is expected to last 12 months or more?
Yes / No / Prefer not to say
- If you answered ‘yes’ please tick if it is either of the following:
Learning Disability
Long standing illness
Mental health condition / Physical impairment
Sensory impairment
Other (please describe):
- Again, if yes, please describe any particular arrangements you would need for your work location:
Candidates name :
6) What is your ethnic group?
Choose one section from A to F, then tick the appropriate box to indicate your cultural background
A: White / Scottish / Irish / Other British
Any other White background
B: Mixed / Any mixed background
C: Asian; Asian Scottish; Asian British
Pakistani / Indian / Chinese
Bangladeshi / Any other Asian background
D: Black; Black Scottish; Black British
Caribbean / African
Any other Black background
E: Other ethnic background
Any other background
F: Prefer not to answer
7) To which religion, religious denomination or body do you actively belong?
(Christianity) - Church of Scotland / Hinduism
(Christianity) - Roman Catholic / Sikhism
Christianity (other) / Judaism
Other faith / belief / Islam
Buddhism / No religion (none)
Prefer not to answer
8) Which of the following best describes your sexual orientation?
Bisexual / Gay Man
Heterosexual / Lesbian/Gay Woman
Other / Prefer not to answer
1