EXTERNAL Application Form

Candidate Application Form
Position applied for*
Reference Number*
Where did you hear about this vacancy?*

Word of MouthStaff ReferralCompany WebsiteInternet SearchJob Board (Indeed, etc)Other
Name of staff member who has referred you
Please note: Existing staff member must also complete an employee referral form to be eligible
Name*

TitleForenamesSurname
Address*

Street Address

Street Address Line 2

CityCounty

Post Code
Mobile number*
Please enter a valid mobile phone number.
Home Phone number
Please enter a valid phone number.
Email address*
example@example.com
Do you require any adjustments to the application process or interview?

YesNo
Supporting Information
Please refer to the role profile and provide detailed evidence of how your skills, experience, and achievements demonstrate your suitability for the role. We shortlist candidates based solely on the information you provide, so please ensure your response is thorough and clearly aligned to the role criteria:
- Why you are interested in this position
- What skills you have that are relevant to the position for which you are applying
- Relevant work experience
Type evidence below:*
Supporting Information: *

Please upload any additional supporting information e.g. CV
Cancelof
Do you have the right to work in the UK?*

YesNo
Are you currently living/working in the UK under a Visa?*

YesNo
Are you registered disabled and therefore do you require any 'reasonable adjustments' to support you in this recruitment process?*

YesNo
Please provide more information:
Any accessibility requirements, sign language interpreter, etc.
Convictions/Disqualifications

All offers of employment made by Benenden Hospital are subject to receipt of a satisfactory DBS check, either standard or enhanced depending on the role being offered.
Are you currently bound over or do you have any unspent convictions issued by a Court or Court Martial in the UK or any other country If yes please supply details below;*

YesNo
If yes please supply details below
Membership of Professional Bodies Any relevant professional registrations or memberships. If you are registered, then please enter the relevant details below; this information will be subject to a satisfactory check.
Professional Body
Membership or registration type
Expiry / renewal date

DayMonthYear
Date
Membership registration number
Fitness to Practice
Have you ever been removed from a professional register?*

YesNo
Have you had any conditions or sanctions placed on your registration?*

YesNo
Have you ever had restrictions placed on your clinical practice as part of the revalidation process?*

YesNo
If you have answered 'yes' to any of the above, please provide us with more information.*
Do you or any close relations hold any interest in a firm or other organisation which:
a) Provides, or has been appointed to provide professional or other services, or goods to Benenden Hospital or the Benenden Group?*

YesNo
b) Competes, or may compete, with Benenden Hospital or Group?*

YesNo
c) Provides professional services and advice to such a competitor?*

YesNo
d) Have you been employed by Benenden Hospital previously?*

YesNo
If you have answered 'Yes' to any of the above questions please provide details below:
Do you hold a full UK driving licence*

YesNo
Employment History
Present most recent Employer*
Your current most recent job title*
Date started*

DayMonthYear
Date
Current salary and benefits*
Overview of duties and responsibilities*
Please provide details
Date left or leaving if working notice*

DayMonthYear
Date
Reason for leaving*
Names of previous employers, job title held and details of main duties, including dates employed:*
Education History: Please include any courses, voluntary work or responsibilities you have obtained that you consider relevant to the position*
Data protection statement

Information from this application may be processed for purposes permitted under the General Data Protection Regulation. Individuals have, on written request, the right of access to personal data held about them.

The organisation treats personal data collected during the recruitment process in accordance with its data protection policy. Information about how your data is used and the basis for processing your data is provided in the Benenden Hospital Privacy Notice, available on our website.

Declaration

I confirm that the above information is complete and correct and that any untrue or misleading information may lead to dismissal. I understand that any offer of employment is subject to the Company being satisfied with the results of series of relevant checks including references, eligibility to work in the UK, criminal convictions, and medical clearance (in line with the operation of the Equality Act 2010).
Signature*

Clear
Print Name*
Date of application*

DayMonthYear
Date
Should be Empty:

Candidate Application Form

Supporting Information

Fitness to Practice

Employment History