Dental Career Development Posts

APPLICATION FOR EMPLOYMENT: PART TWO

Please complete Part Two of this form and check it carefully before returning it to: by 5pmon Wednesday 8 August 2012.Once submitted to the deanery, Part Two of your application will be anonymised and a unique identifier allocated before shortlisting.

Please note incomplete application forms will not be considered.

PROGRAMME APPLIED FOR

Programme applied for / Dental Career Development Post
GDC NUMBER

Please complete all sections of the application form and the declaration.

A: Evidence of Competences and Experience
Do you havea Certificate of Completion of Vocational Training, or have an exemption to undertake vocational training?* / Yes
No
Do you have, or will you have by the start date of the post, a Certificate of Completion of Dental Foundation Year Two?* / Yes
No

*Please note if you have answered “no” to any of these questions, you are not eligible to apply for a Career Development post.

Do you hold the European Computer Driving Licence (ECDL)? / Yes No
If not, do you consider yourself to have equivalent IT skills? / Yes No
Entry Qualification
Please give details of your primary dental qualification
Primary Qualification
Qualification (e.g. BDS):
Date of Qualification (mm/yyyy):
Dental School / University
Dental School / University address:
B:Full Employment history – (UK/Overseas)
Please list all dentalemployment from current/most recent employment history.
Employment Gaps
Do you have any gaps in your employment history of more than 4 weeks duration?* / Yes No
If Yes, please explain the gap and give relevant dates. Please include details with relevant dates of any Observer or Dental Attachment roles you have undertaken here.

Post 1

Employer name / NHS Employer / Yes No
Address
Post Title / Current Level
Specialty
Start Date
End Date / Duration of post: / Years / Months

Post 2

Employer name / NHS Employer / Yes No
Address
Post Title / Grade
Specialty / Current Level
Start Date
End Date / Duration of post: / Years / Months

Post 3

Employer name / NHS Employer / Yes No
Address
Post Title / Grade
Specialty / Current Level
Start Date
End Date / Duration of post: / Years / Months

Post 4

Employer name / NHS Employer / Yes No
Address
Post Title / Grade
Specialty / Current Level
Start Date
End Date / Duration of post: / Years / Months

Post 5

Employer name / NHS Employer / Yes No
Address
Post Title / Grade
Specialty / Current Level
Start Date
End Date / Duration of post: / Years / Months

Post 6

Employer name / NHS Employer / Yes No
Address
Post Title / Grade
Specialty / Current Level
Start Date
End Date / Duration of post: / Years / Months

Post 7

Employer name / NHS Employer / Yes No
Address
Post Title / Grade
Specialty / Current Level
Start Date
End Date / Duration of post: / Years / Months

Post 8

Employer name / NHS Employer / Yes No
Address
Post Title / Grade
Specialty / Current Level
Start Date
End Date / Duration of post: / Years / Months

Post 9

Employer name / NHS Employer / Yes No
Address
Post Title / Grade
Specialty / Current Level
Start Date
End Date / Duration of post: / Years / Months

If necessary, please continue your employment history on a separate sheet.

C: Evidence of Selection Criteria
Please complete ALL parts of this section. If you do not have any evidence please enter ‘No evidence’. Do not leave a section blank.
i) Additional Undergraduate Degrees and Qualifications
Please list any additional undergraduate qualifications with dates. Include intercalated BSc/ equivalent degree here if you have one. Do not include details of your pre-university school education/ exam results.
Qualification * / Place of Study / Grade/Honours / Year
ii) Postgraduate Degrees and Qualifications
Give details of any postgraduate dental qualifications/ other degrees/ diplomas/certificates (e.g. MJDF, MFDS). Please state your exam status. For a PhD please state whether this is linked to your primary dental qualification or the result of an independent research thesis. Please include here any relevant qualifications listed as desirable on the person specification.
Subject/Qualification * / Place of Study / Grade/result / Date (DD/MM/YYYY)
Please note that in order to be eligible to apply for a Dental Career Development Post, you must have passedall parts of MFDS or MJDF and have been awarded the Diploma at the time of application and you must provide details of this in this section.
Additional achievements
Prizes, awards and other distinctions (include specialty and qualifying distinction)
Prize *
(please indicate if an undergraduate or postgraduate award) / Awarding Body / Date Awarded
(mm/yyyy)
Training Courses Attended Since Primary Dental Qualification
Include in this section the most relevant training courses including Continuing Professional Development (CPD) courses that you have attended and details of courses that you are currently undertaking. Please include any Basic and/or Advanced Life Support or similar courses mentioned in the Person Specification
Course Title* / Training Provider / Duration / Date Completed
Supporting Information:
The questions below require you to provide supporting information about your application for the programme.
Academic Achievement and qualifications
Please describe your academic achievements and how they have contributed to your development
Maximum 100 words for this section
Presentations and Publications
In this section, please provide details of any relevant publications in journals or presentations to local bodies, regional or national societies. For publications, please give full citation details of any published work and then state your personal contribution.
200 words maximum
Teaching
What experience do you have of delivering teaching?
100 words maximum
Audit
What experience of clinical audit do you have? Please state clearly when and where your audit(s) were undertaken and what role(s) you undertook.
150 words maximum
Skills, knowledge and experience
Tell us about a skill you found difficult to master (preferably clinical). What strategies did you use to develop the skill and what did you learn from this?
200 words maximum
Management and leadership skills
Please describe any experience of managing people or resources and how your input made an impact
150 words maximum
Management and leadership skills
Give an example that demonstrates your ability to determine priorities and organise your time
150 words maximum
Professionalism and professional development
Explain your reasons for applying for a Dental Career Development post. What makes you suitable for this opportunity?
150 words maximum
Professionalism and professional development
Describe how you would deal with a situation where you had concerns about the quality of a colleague’s work in your training practice
Maximum 150 words
Communications and team working
What attributes do you feel a trainer should possess?
150 words maximum
Communications and team working
Give a recent example that demonstrates the importance of communication and shows that you have the ability to work effectively with others.
150 words maximum
DECLARATION (to be completed by all applicants)
Confirmation*
I confirm that:
I have met/or am expecting to meet the essential entry criteria as set out in the person specification for Dental Foundation 2 posts.
Yes No
Declaration*
I confirm that I have completed this application by myself, fairly and honestly, without significant help or input from other sources.
If it is subsequently discovered that any statement is false, misleading or copied from another source, or that I have withheld relevant information, my application may be disqualified and/or my employment terminated. This may result in a referral to the General Dental Council or other relevant professional body.
Having been allocated to a training opportunity, any subsequent contract of employment will be subject to satisfactory pre-employment checks and subject to the information provided on my application form or any related documents being correct. Pre-employment checks will be carried out to review and confirm the details of my application.
I understand that the information I have provided may be used by recruiting officers in post graduate deaneries and employing organisations to progress my application for a training opportunity; however key personal information, including monitoring data, will not be made available to shortlisting or interview selection panels. I understand that the data will be recorded and processed by authorised recruiting staff in order to process and monitor appointments as well as to produce aggregated recruitment statistics.
Postgraduate deaneries may share information with other deaneries and other organisations involved in the planning, management and delivery of training.
I consent to the recording and processing of personal data in this way in accordance with the Data Protection Act 1998.
I agree to the above declaration.
Please tick the appropriate box: / Yes No
If invited to interview you will be asked to sign your application form during registration. Do not sign or print your name now.

Please ensure you submit all parts of your fully completed application form to by 5pmon Wednesday

8 August 2012. Late applications will not be accepted.

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