Tel: 01886 821279
01886 821697
Dr A J Bywater
Dr J Salter
Dr E A Hinton
APPLICATION FOR EMPLOYMENT
The Surgery
Knightwick
Worcester
WR6 5PH
Position applied for: PART TIME RECEPTIONIST / MEDICAL SECRETARY
Closing date: Friday 27 th
May 2016
Personal details
Surname:
Any previous names:
Forenames:
Current address:
Day time telephone number:
Evening telephone number:
National Insurance
Number:

Tel: 01886 821279
01886 821697
THE JOB YOU HAVE APPLIED FOR
Dr A J Bywater
Dr J Salter
Dr E A Hinton
The Surgery
Knightwick
Worcester
WR6 5PH
Please state what attracted you to the job you have applied for and why you think you would be suitable. Use additional sheets / attach CV if necessary.
Employment history
Present post:
Employer:
Salary and benefits:
Job title:
Date started:

Tel: 01886 821279
01886 821697
Major duties and responsibilities:
Dr A J Bywater
Dr J Salter
Dr E A Hinton
Previous posts (please start with the most recent):
Job title: Employer: Dates (fromto):
Salary:
The Surgery
Knightwick
Worcester
WR6 5PH
Reason for leaving

Tel: 01886 821279
01886 821697
Education/training
Dr A J Bywater
Dr J Salter
Dr E A Hinton
The Surgery
Knightwick
Worcester
WR6 5PH
Secondary education: Dates attended: Qualifications/grade:
Further/higher education: Dates attended:
Qualifications (with date)/grade:
Other relevant training, professional qualifications or work related skills:
Are you undertaking any course of study at present? (if so, please give details)
Do you have membership of any professional bodies? (if so, please give details, including any offices held)

Tel: 01886 821279
01886 821697
Dr A J Bywater
Dr J Salter
Dr E A Hinton
The Surgery
Knightwick
Worcester
WR6 5PH
It is the Surgery's policy to verify any relevant qualifications of all successful job applicants and you may be asked at a later stage in the recruitment process for checks being carried out.
Other details
Is your present post your sole regular employment?
Are you a British subject or a national of any EU country?
If not, do you have the right to work in the UK and a current work permit?
Yes No
If so, please state the expiry date of your right to work in the UK and/or your work permit.
Do you have a full driving licence?
Do you have any current endorsements?
Yes No
Yes No

Tel: 01886 821279
01886 821697
Do you have use of a car?
Dr A J Bywater
Dr J Salter
Dr E A Hinton
Where did you see the advertisement for the post?
The Surgery
Knightwick
Worcester
WR6 5PH
Yes No
Disabilities
Do you require any special arrangements to be made for your
[interview/assessment test] on account of a disability?
Yes No
If "yes", please give brief details of the effects of your disability on your day-to-day activities, and any other information that you feel would help us to accommodate your needs during your [interview/assessment test] and thus meet our obligations under the Equality Act 2010:

Tel: 01886 821279
01886 821697
AVAILABILITY FOR WORK
Dr A J Bywater
Dr J Salter
Dr E A Hinton
The Surgery
Knightwick
Worcester
WR6 5PH
How much notice will you have to give your current employer?
Is there any other reason why you would not be able to start work immediately if you were offered the job you have applied for?
If ‘Yes’, please give details:
Do you have any existing holiday commitments?
Yes
Yes
If ‘Yes’, please give details:
Have you ever been dismissed or been the subject of a disciplinary investigation or proceeding by an employer?
Yes No
If ‘Yes’, please give details, including the reasons given for your dismissal/the detail of the investigation:
No
No

Tel: 01886 821279
01886 821697
References
Dr A J Bywater
Dr J Salter
Dr E A Hinton
The Surgery
Knightwick
Worcester
WR6 5PH
Please give the details of two referees, stating how long you have known them. (One should be your current or most recent employer.) References for shortlisted candidates will be taken up before interview unless you request otherwise. Please note that references are not accepted from close personal friends or relatives.
1. Name: 2. Name:
Address: Address:
Telephone number:
Occupation:
Time known:
May references be taken up before interview?
YES/NO
Telephone number:
Occupation:
Time known:
May references be taken up before interview?
YES/NO

Tel: 01886 821279
01886 821697
Dr A J Bywater
Dr J Salter
Dr E A Hinton
The Surgery
Knightwick
Worcester
WR6 5PH
DECLARATION
I declare that the information I have given on this form (and on any attachments) is true and that I have not withheld any relevant information. I understand that if I have made any false statements or omitted any information I am liable to have my application rejected, or if appointed, liable to disciplinary action which may result in dismissal. I give my permission for my previous employer(s) and any references given to be contacted.
Signed by Applicant:
Date:
EQUAL OPPORTUNITIES
In accordance with our policy on equal opportunities, Knightwick Surgery will provide equal opportunities to any employee or job applicant and will not discriminate either directly or indirectly because race, sex, sexual orientation, gender reassignment, religion or belief, marital or civil partnership status, age, disability or pregnancy and maternity.
Date: