Do you automatically have the right to work in the UK? * Yes No
Do you have a valid work visa to work in the UK? * Yes No
What is your visa type subclass? *
Please give details of your visa exemption *
Have you a current driving license? * Yes No
Please provide the details of your driving license, including any endorsements, eg car, HGV, PSC etc *
Are you currently the subject of any police investigation and/or prosecution, in the UK or any other country? Yes No
Have you ever been convicted of any criminal offence required by law to be disclosed, received a police caution in the UK, or a criminal conviction in any other country? Yes No
Are you currently the subject of any investigation or proceedings by any body having regulatory functions in relation to health/social care professionals including such a regulatory body in another country? Yes No
Have you ever been disqualified from the practice of a profession or required to practise it subject to specified limitations following a fitness to practice investigation by a regulatory body, in the UK or another country? Yes No
Please list any diseases, disorders or allergies from which you have suffered or do suffer.
Please detail any form of medicine or treatment you are currently and/or regularly receiving.
Doctor’s name and address.
Do you have any disabilities which may affect your duties? Yes No
Please provide details
