Job Specific Questions

Protection Questions

*Does your name appear on the Protection of Children Act List? / ¨ Yes ¨ No
*Does your name appear on the Protection of Vulnerable Adults List? / ¨ Yes ¨ No

In order to protect certain vulnerable groups within society, there are a number of posts within the NHS that are exempt from the provisions of the Rehabilitation of Offenders Act 1974. These include positions where there is access to patients in the course of normal duties. As the post you have applied for falls within this category, it will be exempt from the provisions of the Rehabilitation of Offenders Act by virtue of the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975.

Applicants for such posts are not entitled to withhold any information about convictions, cautions, warnings, reprimands and bind-overs which for other purposes are "spent" under the provisions of the Act.If you are successful with this application, any failure to disclose such information could result in dismissal or disciplinary action. Any information provided will be confidential and will be considered only in relation to posts to which the Order applies. Acheck will be made with the Criminal Records Bureau.

Please answer the following question:

* Have you at any time received or had pending a criminal conviction, caution, warning, reprimand or bind-over? / ¨ Yes ¨ No

General Questions

* How much XXXXX experience do you have?
¨ Less than 6 months
¨ 6 months to 1 year
¨ 1 year to 2 years / ¨ 2 years to 3 years
¨ More than 3 years
¨ none
* How much XXXXX experience do you have?
¨ Less than 6 months
¨ 6 months to 1 year
¨ 1 year to 2 years / ¨ 2 years to 3 years
¨ More than 3 years
¨ none
* Do you have XXXXX qualification or equivalent? If this is equivalent, please explain how this is so in the Supporting Information.
¨ Yes
¨ No
* Do you have relevant teaching or training experience as required by the Person Specification?
¨ Yes
¨ No
¨ Not Applicable

Nursing Questions

* Do you have XXXXX registration?
¨ Yes
¨ No
* Does the NMC require you to have a period of supervised practice or to undergo the Overseas Nurses Programme (ONP)?
¨ No
¨ Yes, 3 months supervised practice
¨ Yes, 6 months supervised practice
¨ Yes, ONP / ¨ Yes, ONP + 3 months supervised practice
¨ Yes, ONP + 6 months supervised practice
¨ I don’t have NMC registration
If you have a decision letter for NMC Registration, please enter the date of the decision letter
* How much experience do you have in the specialty associated with this post (if any)?
¨ Less than 6 months
¨ 6 months to 1 year
¨ 1 year to 2 years / ¨ 2 years to 3 years
¨ More than 3 years
¨ None

Medical Questions

* Please state your GMC registration status
¨ I have full registration
¨ I have limited registration
¨ I have provisional registration
¨ I have applied for registration / ¨ I have passed PLAB2
¨ I need to pass PLAB2 before applying for registration
¨ I have not yet applied for registration
If you have limited registration, please explain these limitations in the supporting Information
* Have you completed research work relevant to this post?
¨ Yes
¨ No
¨ Not relevant
* How much experience do you have in the specialty associated with this post (if any)?
¨ Less than 6 months
¨ 6 months to 1 year
¨ 1 year to 2 years
¨ 2 years to 3 years / ¨ More than 3 years
¨ None
¨ Not applicable

Psychologist Questions

* What grade of Psychology degree do you hold?
¨ First class
¨ Upper second / ¨ Lower second
¨ Other

Allied Health Professionals / Healthcare Scientist Questions

* Are you registered with the HPC?
¨ Yes
¨ No
¨ No, I need up to 3 months adaptation / ¨ No, I need 3-6 months adaptation
¨ No, I need 6-12 months adaptation
¨ No, I need more than 12 months adaptation
* Do you hold a relevant degree or graduate diploma as required by the Person Specification?
¨ Yes
¨ No
¨ Not applicable

Health Care Assistant Questions

* How much care experience do you have? This can be personal or professional experience.
¨ Less than 6 months
¨ 6 months to 1 year
¨ 1 year to 2 years / ¨ 2 years to 3 years
¨ More than 3 years
¨ None

Dental Questions

* Please state your GDC registration status
¨ I have full registration (having qualified in the EEA)
¨ I have full registration (via IQE)
¨ I have temporary registration
¨ I am not yet registered but have passed IQE Parts A, B & C / ¨ I am not yet registered but have passed IQE Parts A and B
¨ I am not yet registered but have passed IQE Part A
¨ I need to pass all parts of IQE before I can register
¨ I am not registered but am an EEA dental graduate
* Please select your Royal College
¨ Royal College of Anaesthetists
¨ Royal college of General Practitioners (UK)
¨ Royal College of Obstetricians and Gynaecologists (UK)
¨ Royal College of Ophthalmologists (UK)
¨ Royal College of Paediatrics and Child Health (UK)
¨ Royal College of Pathologists (UK)
¨ Royal College of Physicians and Surgeons of Glasgow (UK)
¨ Royal College of Physicians of Edinburgh (UK) / ¨ Royal College of Physicians of London (UK)
¨ Royal College of Psychiatrists (UK)
¨ Royal College of Radiologists (UK)
¨ Royal College of Surgeons of Edinburgh (UK)
¨ Royal College of Surgeons of England (UK)
¨ Faculty of Public Health Medicine (UK)
¨ Faculty of Pharmaceutical Medicine (UK)
¨ Faculty of Occupational Medicine (UK)
¨ Not applicable
* Please select your Royal College membership status
¨ Fellow
¨ Member
¨ Associate
¨ Affiliate / ¨ Junior
¨ Full
¨ Other
¨ Not applicable
* How long have you worked as a dentist?
¨ Less than 6 months
¨ 6 months to 1 year
¨ 1 year to 2 years
¨ 2 years to 3 years / ¨ More than 3 years
¨ None
¨ Not applicable

Driving Licence Questions

* How many penalty points do you currently have on your driving license?
¨ 0
¨ 1-3 / ¨ 4-6
¨ 7-9
¨ 10-12