Scotland Deanery Ref: PaedsScotR2/18
Paediatrics Application Pack
Please complete all information required within this pack. This
ensures we can process your application as easily as possible.
You must return by email the full complete Job Pack:-
- Sections 1 – 6
- Full Application Form
Return to:
May we take this opportunity to thank you for your interest in
gaining employment within Scotland Deanery.
Scotland Deanery – Application PackSECTION 1 PERSONAL AND RECRUITMENT SOURCE INFORMATION
Please complete and return with your Application form. Your application cannot be considered without this information
TitleForename
Surname
Reference / PaedsScotR2/18 / Quote on all correspondence
Location / Scotland
Post Title / Please circle level: Locum Appointment for Training LAT1, LAT2, LAT3, LAT4 Level
LAS / CF
Closing Date / 12 noon on 26/04/18
Personal Information
*Disclosure Scotland Protection of Vulnerable Groups Scheme Number
Membership of the Protection of Vulnerable Groups (PVG) Scheme is a condition of this post and the successful applicant(s) will require to join the scheme prior to appointment. Further information on scheme membership is included within the application pack, and can also be found at / Address
Telephone
GMC Number / License to Practice / YES / NO
PVG* Membership Number
(If registered)
Current PVG Membership Relates to regulated work with: / Children only Yes / No
Protected Adults only Yes / No
Both Yes/ No
Working in the UK? / Do you have an unrestricted right to work in the UK, e.g. UK/EEA citizen or have indefinite leave to remain. / Yes
No
Please complete Immigration Status at Section 3
SECTION 2 REFERENCES
Your referees will include your present (or most recent) employer. Please identify below the person in your organisation (for current NHS staff this is your direct line manager/Clinical or Educational Supervisor) who is authorised to confirm your employment and the details given in your application. Please identify a second referee who may have closer knowledge of your skills, knowledge and abilities and who may offer opinion on your suitability for this post. Note that references will be taken up for candidates prior to interview.
Reference 1 / Name
Position
Address
Telephone
Reference 2 / Name
Position
Address
Telephone
SECTION 3 DECLARATIONS AND CONVICTIONS
Declaration Statement regarding:-
A - Any criminal offence, being bound over or cautioned, or current proceedings which might lead to a conviction, an order binding you over a caution and
B - Fitness to practice proceedings taken or being currently contemplated by a licensing/regulatory body.
If answer “Yes” to questions 1 – 10 please provide details at 11
NB – You do not need to tell us about parking offences.
1 Are you currently bound over or have you ever been convicted of any offence by a Court or Court-Martial in the United Kingdom or in any other country? / No
Yes*
*If YES / Please provide details of the order binding you over and/or the nature of the offence, the penalty, sentence or order of the Court, and the date and place of the court hearing.
2 Have you ever received a police caution, reprimand or final warning? / No
Yes*
*If YES / Please include details of the caution, reprimand or final warning, including the date and reason administered.
3 Have you been charged with any offence in the United Kingdom or in any other country that has not yet been disposed of? / No
Yes*
NB You must inform us immediately if you are charged with any offence in the UK or in any other country after you complete this form and before taking up any position offered to you
*If YES / Please include details of the nature of the offence with which you are charged, date on which you are charged, and details of any on-going proceedings by a prosecuting body.
4 Are you aware of any current police investigation in the United Kingdom or in any other country following allegations made against you? / No
Yes*
*If YES / Please include details of the nature of the allegations made against you, and if known to you, any action to be taken against you by the police.
5 Are you aware of any current NHS Scotland Counter Fraud Services investigations following allegations made against you? / No
Yes*
*If YES / Please include details of the nature of the allegations made against you, and if known to you, any action to be taken by Counter Fraud Services.
6 Have you ever been investigated by the police, NHS Scotland Counter Fraud Services or other investigatory body resulting in a caution, conviction or dismissal from your employment? / No
Yes*
NB Investigatory bodies include (List not exhaustive):- Local Authorities, Customs and Excise, Immigration, Passport Agency, HMRC, Department of Trade and Industry, Department of Work and Pensions, Security Agencies, Financial Service Authority, Banks and Building Societies, Life Insurance Companies.
*If YES / Please include details of the nature of the allegations made against you, and if known to you, any action to be taken by the Investigatory Body.
7 Have you ever been dismissed by reason of misconduct from any employment, office or other position held by you? / No
Yes*
*If YES / Please include details of the employment, office or position held, the date you were dismissed and the nature of the allegations of misconduct.
8 Have you ever been disqualified from the practice of a profession, or required to practice subject to specified limitations following fitness to practice proceedings, by a regulatory or licensing body in the United Kingdom or in any other country? / No
Yes*
*If YES / Please include details of the nature of the disqualification, limitation or restriction, the date, and the name and address of the licensing or regulatory body concerned.
9 Are you currently the subject of any investigation or fitness to practice proceedings by any licensing or regulatory body in the United Kingdom or in any other country? / No
Yes*
*If YES / Please include details of the reason given for the investigation and/or proceedings undertaken, the date, details of any limitation or restriction to which you are currently subject, and the name and address of the licensing or regulatory body concerned.
10 Are you subject to any other prohibition, limitation or restriction that means we are unable to consider you for the position for which you are applying? / No
Yes*
*If YES / Please include details of the reason given for the investigation and/or proceedings undertaken, the date, details of any limitation or restriction to which you are currently subject, and the name and address of the licensing or regulatory body concerned.
11 If you have answered YES to any of the questions above, please use this space to provide details. Please indicate the number(s) of the questions you are responding to.
SECTION 4 IMMIGRATION STATUS
Please complete and return along with your application. If invited for interview you will be asked to provide evidence to confirm your immigration status. Please note failure to evidence your right to work/immigration status at time of interview, will invalidate your application, and will lead to your application being withdrawn.
Evidence of your status includes:
Original Passport (personal details)
Visa (if applicable)
Original letter/s from the Home Office/UK Border Agency/Immigration & Nationality Directorate (if applicable)
- Bulgarian/Romanian Citizens will require a Work Permit and Accession Worker Card (form BR3)
Dependant Visa Status
If you are the dependant of a current visa holder, you will be required to provide evidence of your name as the dependant on any documentation/visa.
Immigration StatusNHS Ayrshire and Arran
Full Name:
Post Applied for:
Post Ref No.: / PaedsScotR2/18 Office Use Only
PLEASE READ ALL QUESTIONS CAREFULLY BEFORE COMPLETING THIS FORM
We need to know if you are eligible for employment in the UK EVEN IF YOU ARE A BRITISH CITIZEN.
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.
Please use BLOCK CAPITALS and tick the appropriate responses
1 / Are you a British Citizen or a European Economic Area National?
If you have answered NO, please answer questions 2-7 and 8
If you have answered YES, please go straight to question 8 / YES / NO
2 / Do you have right of residence in the European Economic Area? / YES / NO
3 / Passport Expiry date / Day: / Month: / Year:
4 / Date of Entry to the UK / Day: / Month: / Year:
5 / Please indicate which Immigration Status applies to you:
OOwn Visa Status
/ /Dependant Visa Status
(Spouse/Partner/Civil Partner of Visa Holder) / UK/EEA nationalTier 1 (General) Points Based / Tier 1 (General) / Clinical Attachment / Observer
Tier 1 (Post Study Work)
Points Based / Tier 1 (Post Study Work) / Medical Training Initiative
Tier 2 Certificate of Sponsorship
(formerly Work Permits) / Tier 2 Dependant
National Identity Card / National Identity Card
Tier 4 (General Student) / n/a
Tier 4 (Student Visitor) / n/a
Refugee / Asylum / Refugee / Asylum
UK Ancestral Visa / UK Ancestral Visa
Other – please specify:
7 / Date period of entry to UK ceases (visa expiry) / Day: / Month: / Year:
If you have answered questions 2 to 7, please attach copies of the following documentation (originals will be checked at interview):
8 / I confirm that the information provided on this form is to the best of my knowledge correct.
I understand that failure to provide appropriate evidence on request will mean my application cannot be considered further.
SIGNATURE / DATE
SECTION 5 EQUAL OPPORTUNITIES
Job Reference Number: / PaedsScotR2/18NAME (PRINTED)
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 (Part D), 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:
(Continued on next page)
Part DCandidate identification number (office use only):
Job reference number: / PaedsScotR2/18
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
SECTION 6 DECLARATION
Please read and confirm you have read the following statements:-- I have completed all the relevant parts of the application pack and confirm the details supplied on my CV are, to the best of my knowledge, true and complete.
- I understand that if appointed to this post, the information on this form will be kept as part of my personnel file record.
- I authorise you to obtain my references to support this application and understand these are required prior to the interview stage.
- I understand that details of educational qualifications, membership or professional bodies and referee reports may be verified through the establishments and individuals I have indicated.
- I consent to my details being kept confidentially and used for the specific and lawful purposes as specified in the Data Protection Act 1998.
- I declare that I have no previous convictions, or have identified any I have above.
- I can confirm I have read, agree and understand this declaration
Insert
Name/Electronic Signature / Date / / /
Scotland Deanery Paediatric Training Programme
Paediatrics ST 1-4 level
Locum Appointment for Training (LAT)/
Locum Appointment for Service (LAS)/Clinical Fellow (CF) posts
Opportunities August 2018
Salary LAT (StR) £31,220 - £49,091 per annum
Applications are invited for LAT/LAS/CF posts at LAT level 1-4 commencing 01 August 2018. The full range of posts are still being finalised, opportunities are available in West and SE Scotland but there may also be some posts available in the other two Scottish Deanery regions. There are likely to be some fixed term 6-month posts but also some 12-month rotations. For those offered an initial six month post there may be a possibility to extend the appointment to the end of the training year and any extension may be at any of the hospitals in that training region.
The offer of LAT/LAS/CF posts allows flexibility between those candidates who wish to, and are capable of engaging in training (LAT) and those who are seeking employment without commitment to training progression (LAS/CF)
Documented competences achieved through a LAT can count towards CCT if subsequently appointed to a Paediatric Specialty Training Programme, or, towards a CESR application for those who do not enter Paediatric Training.
The ‘Locum Appointment for Training’ placements and/or programmes are educationally approved by the Dean.
These posts are open to both EEA and non-EEA applicants. Immigration information is available at http://www.ukba.homeoffice.gov.uk/visas-immigration/working/
Please complete the Scotland Paediatric Job Application Pack which must be submitted electronically, this must include details of your Immigration Status, GMC Registration with a Licence to Practice and the names and addresses of two referees including current email addresses (one of which should be your current or most recent employer) to: by the closing date.
Please request the Job Pack from to ensure the correct Application form is completed. No applications will be accepted by post or fax. No CVs please.
Please Quote Ref No: PaedsScotR2/18Closing Date: 26 April 2018 at noon
Interviews22 May 2018
VenueStirling Court Hotel, Stirling
Person Specifications can be found at:
Further Information on Speciality Training in Paediatrics Scotland can be found at:
NHS Ayrshire & Arran are hosting this recruitment process on behalf of Scotland NHS Boards.
NHS Scotland
Application
- Confidential -
Application for post of: / PaediatricsPlease circle to specify level: LAT1, LAT2, LAT3, LAT4 level / LAS / CF
Location: / Various Health Boards within the Scotland Deanery
Post Ref No: / PaedsScotR2/18
Closing Date: / 12 noon on 26/04/18
Name
Personal Information / Address
Telephone
1 Medical education, any other professional degrees or qualifications, undergraduate awards, prizes distinctions etc
Qualifications obtained (please state if part qualified) membership of professional institutions
Date from Date to Award, Degree, prize etc
2. Detail of current (or most recent) post
Job title:
Speciality:
Grade: / FY2 / ST / FTSTA / LAT / LAS / Other:
Employer:
Location:
Dates employment started and (if applicable) finished: / From: / To:
Was this role a research post? / Yes / No
If yes, are you on an on-call rota? / Yes / No
If yes, how often and at what grade?
What proportion of your time is spent on clinical work?
Role and summary of duties
3. Other previous posts held since graduation from medical school
Please put in chronological order, and provide reasons for any gaps in employment. Please also include details of previous, current and future employment you know of together with details of your employer and a brief summary of your role.
Dates from Dates to
4 Clinical Competence
Please highlight below the competences you have achieved that you feel are particularly relevant to this application, e.g. procedures and to what level of competence, level of involvement in acute take, clinical courses attended. Please refer to the relevant person specification. Max 200 words
5 Commitment to specialty
Please provide details as to what steps you have taken to show commitment to this specialty (e.g., membership of societies, attendance at meetings, courses or exams undertaken, taster placements, specific electives, etc.) Max 200 words
6 Audit, research and presentations
Please detail what audit and/or research work you have undertaken, including details of publications and presentations. Specify to what extent you initiated the work, undertook and analysed it; if and how the audit loop was closed, type of meeting where any presentation took place and publication format and journal.
NOTE do NOT give names in presentation or publication citations but list title, journal/conference, date, volume and pages. Please indicate where in the authorship you are (e.g. first, third author etc).
Max 300 words
7 Teaching and organisational activity
Please provide details of your involvement in teaching activities (including when, how and formal/informal) and other work-related organisational activities (e.g. rota co-ordinator, representative roles etc., including when and what this involved.) Max 200 words
8 Leadership involvement
Please detail dates, type and level (local / national; senior / junior; school / university) of any experience you have of leadership roles in either medical or non-medical fields, e.g. team, organisation or group leader. Explain how this is relevant to your application. Max 200 words
9 Personal achievements and qualities
Please detail non-medical activities you have undertaken and how they demonstrate your personal qualities (e.g. volunteer work, sporting & performance arts activities): Specify dates, your role (member / leader) and the level (junior / senior: local / national). Please also highlight how these achievements and qualities enhance your approach to medicine. Max 200 words
10 Personal statement in support of your application
Please tell us in, why you wish to apply for this post and highlight the experience you have gained relevant to this position. Max 250 words
Additional Information may be obtained from the following links: