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Noticeboard



Please try to keep the car park free for Ambulances and Blue Badge holders.  The Walk in Centre accepts no responsibility for any damage that may be caused whilst using the car park. 


We are open from 8.00am to 8.00pm at weekends and  on ALL Bank Holidays!


(Last appointment 7.45)


Salisbury Walk in Health Centre has been rated as
GOOD
By the Care Quality Commission

Application Form

Salisbury Walk in Health Centre

 

APPLICATION FORM

Please complete all sections of this application form and then return this application form to:

 

Salisbury Walk In health Centre

Avon Approach

Salisbury

SP1 3SL

 

This form should be printed and completed legibly using BLACK INK & IN CAPITAL LETTERS, continuing on a separate sheet if necessary.

 

 

Position applied for:

 

 

Where did you hear about this vacancy?

 

 

Other employment interests:

 

 

When would you be available to start?

 

 

If offered this position will you continue to work in any other capacity?     

YES  NO

 

 

Have you previously worked for us?  YES  NO 

 

If yes, when?

 

 

 

Personal Details;

 

Title:

 

Surname: 

 

Forenames:

 

Address: 

 

 

 

Postcode: 

 

Telephone:  Home  Work  Mobile

 

Email:

 

National Insurance Number:

 

GMC / NMC Number (Clinical positions only):

 

 

 

 

 

IN CONFIDENCE

 

EQUAL OPPORTUNITIES RECRUITMENT MONITORING POLICY

 

Salisbury Walk in Health Centre operates an equal opportunities policy which requires fair and equal treatment of all job applicants.  To help check whether this policy is working the practice monitors the ethnic origin, marital status and gender of all applicants and whether applicants are in any way disabled.  For this reason you are asked to complete the following sections.

 

 

Please complete these forms and return with your application so the practice can monitor the success of its Equal Opportunities Employment Policy.

 

 

 

APPLICATION FOR POST:

 

PERSONAL DETAILS

 

Title:

 

Forenames:

.

Surname:     

 

Previous Surname:

 

Address: 

 

 

 

Postcode:

 

Age:

 

D.O.B: 

 

Telephone: 

 

Home:

 

Work:

 

 

 

 

GENERAL INFORMATION

 

Sex:  Male  Female

 

Marital Status:

 

Country of Birth:

 

Are you a European Economic Area National? YES NO

 

If appointed would you require a work permit for this post? YES NO

 

 

 

DISABILITY

The successful candidate will be required to complete a medical questionnaire and may have to undergo a medical examination.

If you have any reason or disability which may prevent you from carrying out the full duties of the post please give details below.

The practice will make reasonable adjustments to working arrangements.

 

Do you have a disability? YES NO

 

Please give details of your disability:

 

 

ETHNIC ORIGIN  (please tick the box)

Ethnic origin questions are not about the nationality, place of birth or citizenship of applicants.  They are instead about colour and broad ethnic group.  UK citizens can belong to any of the groups indicated.

 

Ethnic Categories                Code          Please tick

White

 

 

British

A

 

Irish

B

 

Any other White background

C

 

Mixed

 

 

White & Black Caribbean

D

 

White & Black African

E

 

White & Asian

F

 

Any other mixed background

G

 

Asian or Asian British

 

 

Indian

H

 

Pakistani

J

 

Bangladeshi

K

 

Any other Asian background

L

 

Black or Black British

 

 

Caribbean

M

 

African

N

 

Any other Black background

P

 

Other Ethnic groups

 

 

Chinese

R

 

Any other Ethnic group

S

 

Not stated

Z

 

 

 

Signature:

 

Date:

 

 

Thank you for completing the Equal Opportunities Form.

 

The information provided will not be given to the selection panel, and will be used solely for the purposes of Equal opportunities monitoring.

 

 Salisbury Walk in Health Centre

 

References

 

 

NAME: 

 

POST:

 

Please give name and address of at least two references, one of which must be your current or last employer.

 

References will not be used in the short-listing process.  References will only be requested once you have been short-listed and selected for interview.  All positions are offered subject to references that are satisfactory to the practice.

 

Ref 1

 

Title:

 

Surname: 

 

Forenames:

 

Address: 

 

 

 

Postcode: 

 

Telephone: Home: Work Mobile:

 

Email:

 

Please indicate how these individuals know you and how they know about your work abilities etc. e.g. state whether they are your current manager etc.

 

 

 

 

 

 

 

 

Ref 2

 

Title:

 

Surname: 

 

Forenames:

 

Address: 

 

 

 

Postcode: 

 

Telephone: Home: Work Mobile:

 

Email:

 

Please indicate how these individuals know you and how they know about your work abilities etc. e.g. state whether they are your current manager etc.

 

 

 

 

 

 

Salisbury Walk in Health Centre

 

Application Form

 

 

NAME: Position:

 

You are asked to complete the following questions which are used by the short-listing panel to determine whether you will be invited for an interview.

 

 

1. Qualifications.   Please list all relevant qualifications.

 

Date

Qualifications obtained

Awarding Body

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2. ADDITIONAL COURSES. Please list all relevant courses.

 

Date

Details

Organisation/Training Provider etc..

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

3. PRESENT/LAST EMPLOYER

 

Name and address of employer

 

 

 

 

 

 

Full or part time post

Job title and responsibilities

 

 

 

 

 

 

Date joined company

 

 

 

 

 

4. Previous Employment.  Please list all previous posts and include dates and present employment (if applicable). Please start with your most recent and work back from there. Please account for any gaps in employment

 

Name and address of employer

Job title

Description of duties and responsibilities

From- To

Reason for leaving

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

5. DESCRIBE THE SKILLS, EXPERIENCE AND QUALIFICATIONS YOU HAVE THAT EVIDENCE YOUR ABILITY TO MEET THE JOB DESCRIPTION AND PERSON SPECIFICATION REQUIREMENTS.

IF YOU HAVE A CURRICULUM VITAE, PLEASE ATTACH IT TO THIS APPLICATION.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

6. OTHER INFORMATION

 

 

Yes

 

No

Do you have a current driving licence?

 

 

 

If yes, please specify type (motor car, motor cycle etc)

 

Do you have any driving endorsements?

 

 

 

If yes, please give details

 

 

 

7. DECLARATION OF CRIMINAL RECORD

 

The Rehabilitation of Offenders Act 1974 permits persons in certain circumstances to ignore offences committed in the past when asked to give details of previous convictions. These convictions are known as ‘’spent convictions’’. However the Exceptions Order of 1975 states that those employed in the medical/care fields are not allowed to withhold details of any offences for which they have been convicted, however long ago these convictions may have been served.

 

Yes

No

Have you ever been convicted by the courts or cautioned, reprimanded or given a final warning by the police?

 

 

 

If yes, please give details of offences, penalties and dates

 

 

 

Are you aware of any police enquires undertaken following allegations made against you, which may have a bearing on your suitability for this post?

 

 

 

 If yes, please give details

 

 

 

Do you have a Police Check Statement?

 

 

 

Date of last Police Check :  



 
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