Please complete all information required within this pack. This
ensures we can process your application as easily as possible.
You must return by email: A full, up-to-date CV
 The full, completed application pack sections 1 - 6
 Eligibility for CCT Certificate (if appropriate)
Return to:
Gillian.fullerton@aapct.scot.nhs.uk
May we take this opportunity to thank you for your interest in
gaining employment with NHS Ayrshire & Arran.
NHS Ayrshire and Arran – Application Pack
SECTION 1 PERSONAL AND RECRUITMENT SOURCE INFORMATION
Please complete and return with your CV. Your application cannot be considered without this information
Title
Forename
Surname
Reference
Location
Post Title
Closing Date
Personal
Information
MD/
Quote on all correspondence
Address
EMail
Telephone
GMC Number
* Disclosure Scotland
Protection of Vulnerable
Groups Scheme Number
License to
Practice
PVG* Membership
Number
(If registered)
Current PVG
Children only
Membership
Protected Adults only
Relates to
Both
regulated work with:
Working in the
UK?
Do you have an unrestricted right to work in
the UK, e.g. UK/EEA citizen or have
indefinite leave to remain.
Please complete Immigration Status at Section 3
YES / NO
Yes / No
Yes / No
Yes/No
Yes
No
Driving Licence
Do you have a Driving Licence which allows Yes
you to drive in the UK?
No
How did you
hear about the
vacancy you
have applied for
(response
essential for
recruitment
monitoring
purposes)
www.medicaljobs.scot.nhs.uk
Newspaper - Which one?
BMJ
Internal Vacancy Bulletin
SHOW (Scotland Health on the Web)
Word of Mouth
Doctors.net
Other – Please specify.
SECTION 2 REFERENCES
Your referees will include your present (or most recent) employer. Please identify below the
person in your organisation (for current NHS staff this is your direct line manager) who is
authorised to confirm your employment and the details given in your application. Please
identify a second referee who may have closer knowledge of your skills, knowledge and
abilities and who may offer opinion on your suitability for this post. Note that references will
be taken up for candidates prior to interview.
Reference 1
Name
Position
Address
EMail
Telephone
Reference 2
Name
Position
Address
EMail
Telephone
SECTION 3 DECLARATIONS AND CONVICTIONS
Declaration Statement regarding:A - Any criminal offence, being bound over or cautioned, or current proceedings which might
lead to a conviction, an order binding you over a caution and
B - Fitness to practice proceedings taken or being currently contemplated by a
licensing/regulatory body.
If answer “Yes” to questions 1 – 10 please provide details at 11
NB – You do not need to tell us about parking offences.
1 Are you currently bound over or have you ever been No
convicted of any offence by a Court or Court-Martial in the
Yes*
United Kingdom or in any other country?
*If YES
Please provide details of the order binding you over and/or the nature of
the offence, the penalty, sentence or order of the Court, and the date and
place of the court hearing.
2 Have you ever received a police caution, reprimand or No
final warning?
Yes*
*If YES
Please include details of the caution, reprimand or final warning, including
the date and reason administered.
3 Have you been charged with any offence in the United No
Kingdom or in any other country that has not yet been Yes*
disposed of?
NB You must inform us immediately if you are charged with any offence in the UK or in any
other country after you complete this form and before taking up any position offered to you
*If YES
Please include details of the nature of the offence with which you are
charged, date on which you are charged, and details of any on-going
proceedings by a prosecuting body.
4 Are you aware of any current police investigation in the No
United Kingdom or in any other country following Yes*
allegations made against you?
*If YES
Please include details of the nature of the allegations made against you,
and if known to you, any action to be taken against you by the police.
5 Are you aware of any current NHS Scotland Counter Fraud No
Services investigations following allegations made against Yes*
you?
*If YES
Please include details of the nature of the allegations made against you,
and if known to you, any action to be taken by Counter Fraud Services.
6 Have you ever been investigated by the police, NHS No
Scotland Counter Fraud Services or other investigatory Yes*
body resulting in a caution, conviction or dismissal from
your employment?
NB Investigatory bodies include (List not exhaustive):- Local Authorities, Customs and Excise,
Immigration, Passport Agency, HMRC, Department of Trade and Industry, Department of
Work and Pensions, Security Agencies, Financial Service Authority, Banks and Building
Societies, Life Insurance Companies.
*If YES
Please include details of the nature of the allegations made against you,
and if known to you, any action to be taken by the Investigatory Body.
7 Have you ever been dismissed by reason of misconduct No
from any employment, office or other position held by you? Yes*
*If YES
Please include details of the employment, office or position held, the date
you were dismissed and the nature of the allegations of misconduct.
8 Have you ever been disqualified from the practice of a No
profession, or required to practice subject to specified
limitations following fitness to practice proceedings, by a Yes*
regulatory or licensing body in the United Kingdom or in
any other country?
*If YES
Please include details of the nature of the disqualification, limitation or
restriction, the date, and the name and address of the licensing or
regulatory body concerned.
9 Are you currently the subject of any investigation or No
fitness to practice proceedings by any licensing or
Yes*
regulatory body in the United Kingdom or in any other
country?
*If YES
Please include details of the reason given for the investigation and/or
proceedings undertaken, the date, details of any limitation or restriction to
which you are currently subject, and the name and address of the
licensing or regulatory body concerned.
10 Are you subject to any other prohibition, limitation or No
restriction that means we are unable to consider you for the
Yes*
position for which you are applying?
*If YES
Please include details of the reason given for the investigation and/or
proceedings undertaken, the date, details of any limitation or restriction to
which you are currently subject, and the name and address of the
licensing or regulatory body concerned.
11 If you have answered YES to any of the questions above, please use this space to
provide details. Please indicate the number(s) of the questions you are responding to.
SECTION 4 IMMIGRATIONSTATUS
Please complete and return along with your application. If invited for interview you will be asked to
provide evidence to confirm your immigration status. Please note failure to evidence your right to
work/immigration status at time of interview, will invalidate your application, and will lead to your
application being withdrawn.
Evidence of your status includes:
 Original Passport (personal details)
 Visa (if applicable)
 Original letter/s from the Home Office/UK Border Agency/Immigration & Nationality
Directorate (if applicable)
 Bulgarian/Romanian Citizens will require a Work Permit and Accession Worker Card
(form BR3)
Dependant Visa Status
If you are the dependant of a current visa holder, you will be required to provide evidence of your name
as the dependant on any documentation/visa.
Immigration Status
NHS Ayrshire and Arran
Full Name:
Post Applied for:
Office Use Only
Post Ref No.:
PLEASE READ ALL QUESTIONS CAREFULLY BEFORE COMPLETING THIS FORM
We need to know if you are eligible for employment in the UK EVEN IF YOU ARE A BRITISH CITIZEN.
The information you provide in this part of the form is confidential and is not used in the selection process. It
will be separated from the rest of the form when we receive it.
Please use BLOCK CAPITALS and tick the appropriate responses
1
Are you a British Citizen or a European Economic Area National?
If you have answered NO, please answer questions 2-7 and 8
If you have answered YES, please go straight to question 8
YES
NO
2
Do you have right of residence in the European Economic Area?
YES
NO
3
Passport Expiry date
Day:
Month:
Year:
4
Date of Entry to the UK
Day:
Month:
Year:
5
Please indicate which Immigration Status applies to you:
Dependant Visa Status
OOwn Visa Status
(Spouse/Partner/Civil
Partner of Visa Holder)
UK/EEA national
7
Tier 1 (General) Points Based
Tier 1 (Post Study Work)
Points Based
Tier 2 Certificate of Sponsorship
(formerly Work Permits)
National Identity Card
Tier 1 (General)
Clinical Attachment / Observer
Tier 1 (Post Study Work)
Medical Training Initiative
Tier 4 (General Student)
n/a
Tier 4 (Student Visitor)
n/a
Refugee / Asylum
Refugee / Asylum
UK Ancestral Visa
Other – please specify:
UK Ancestral Visa
Date period of entry to UK ceases (visa expiry)
Tier 2 Dependant
National Identity Card
Day:
Month:
Year:
If you have answered questions 2 to 7, please attach copies of the following documentation (originals will be
checked at interview):
8
I confirm that the information provided on this form is to the best of my knowledge correct.
I understand that failure to provide appropriate evidence on request will mean my application cannot
be considered further.
SIGNATURE
DATE
SECTION 5 EQUAL OPPORTUNITIES
Job Reference Number:
NAME (PRINTED)
Equal opportunities monitoring
We want to ensure that our job opportunities are open to all. The only way we can ensure there is
equal opportunity is to monitor applications we receive, and compare the profile of people who
apply with those appointed. Therefore this form asks you for your ethnic origin, gender, disability,
religion, sexuality and age. The information you provide in this part of the form (Part D), is
confidential and is not used in the selection process. It will be separated from the rest of
the form when we receive it.
1) If you are currently an employee of this NHS Board, will getting this job be a promotion?
Yes
No
2) You are:
Female
Male
3) Have you undergone, are you undergoing or do you intend to undergo gender
reassignment? For example, this includes having changed your sex (gender).?
Yes
No
Prefer not to say
4) What is your age?
I am
years old, and my date of birth is:
5) Do you have a physical or mental health condition or disability that:


Yes

has a substantial effect on your ability to carry out day to day activities?
has lasted or is expected to last 12 months or more?
No
If you answered ‘yes’ please tick if it is either of the following:
Learning Disability
Long standing illness
Mental health condition
Other (please describe):

Prefer not to say
Physical impairment
Sensory impairment
Again, if yes, please describe any particular arrangements you would need for your work
location:
(Continued on next page)
Part D
Candidate identification number (office use only):
Job reference number:
6) What is your ethnic group?
Choose one section from A to F, then tick the appropriate box to indicate your cultural background
A: White
Scottish
Irish
Other British
Any other White background
B: Mixed
Any mixed background
C: Asian; Asian Scottish; Asian British
Pakistani
Indian
Bangladeshi
Chinese
Any other Asian background
D: Black; Black Scottish; Black British
Caribbean
African
Any other Black background
E: Other ethnic background
Any other background
F: Prefer not to answer
7) To which religion, religious denomination or body do you actively belong?
(Christianity)- Church of Scotland
Hinduism
(Christianity) - Roman Catholic
Sikhism
Christianity (Other)
Judaism
Other faith / belief
Islam
Buddhism
No religion (none)
Prefer not to answer
8) Which of the following best describes your sexual orientation?
Bisexual
Gay Man
Heterosexual
Lesbian/Gay Woman
Other
Prefer not to answer
SECTION 6 DECLARATION
Please read and confirm you have read the following statements: I have completed all the relevant parts of the application pack and confirm the details supplied on
my CV are, to the best of my knowledge, true and complete.
 I understand that if appointed to this post, the information on this form will be kept as part of my
personal file record.
 I authorize you to obtain my references to support this application and understand these are
required prior to the interview stage.
 I understand that details of educational qualifications, membership or professional bodies and
referee reports may be verified through the establishments and individuals I have indicated.
 I consent to my details being kept confidentially and used for the specific and lawful purposes as
specified in the Data Protection Act 1998.
 I declare that I have no previous convictions, or have identified any I have above.
 I can confirm I have read, agree and understand this declaration
Insert
Name/Electronic
Signature
Date
/
/
NHS AYRSHIRE AND ARRAN
UNIVERSITY HOSPITAL CROSSHOUSE
LAS (Lower Level) IN OBSTETRICS AND GYNAECOLOGY
MD/748/14
We are looking for a committed individual to join our busy department as a Locum Appointment for
Service, commencing immediately until 4 August 2015. This is an excellent opportunity for enthusiastic
candidates at ST1 or ST2 level to benefit from a post within the department of Obstetrics and
Gynaecology. Candidates at FY2 level may also be considered.
The new Unit is fully equipped for modern Maternity care. The labour suit is divided into Obstetric and
Midwifery areas and has two dedicated operating theatres. We also have a well developed early
pregnancy assessment suite, modern ultrasound department, and out patient clinic, and areas for
acute receiving and day monitoring. Gynaecology is served by a dedicated in-patient ward as well as
day ward/theatre. We also have excellent facilities for “office” gynaecology.
The successful candidate must be fully registered with the GMC with a current Licence to Practice, and
be able to evidence achievement of Foundation competencies. National Terms and Conditions of
Service apply.
This is post is not an educationally recognised post, however, you will receive the same training and
educational opportunities available to all junior staff. In addition, we have an excellent Education
Centre and Medical Library, and you will be encouraged to avail yourself of all the training opportunities
available.
Informal enquiries should be made to Dr Vivian Franklin, or Kirstyn Brogan, Obstetric Consultants,
University Hospital Crosshouse (telephone 01563 825426).
Applications in the form of a current CV (together with the names and addresses of 2 referees) should
be submitted electronically to Gillian.fullerton@aapct.scot.nhs.uk
no later than 4 April 2015, quoting reference number MD/748/14. Successful candidates will be
asked to attend for interview shortly thereafter and may phone to visit the unit prior to interview.
Job Packs, including job description, are available for download at www.jobs.scot.nhs.uk. Details of all
our Medical Posts can be found at www.medicaljobs.scot.nhs.uk. You can also obtain further
information about the organisation at www.nhsaaa.net
NHS AYRSHIRE AND ARRAN
UNIVERSITY HOSPITAL CROSSHOUSE
LOCUM APPOINTMENT FOR TRAINING (LAS) – LOWER LEVEL
OBSTETRICS/GYNAECOLOGY
JOB DESCRIPTION
Ayrshire and Arran Health Board is responsible for arranging health care services for approximately
375,000 patients. Ayrshire Central Hospital is the only specialist Obstetric Unit within the Board’s area,
part of the NHS Ayrshire and Arran. Maternity care is based in a new unit, built adjacent to University
Hospital Crosshouse, which opened in August 2006.
A new purpose built gynaecology ward opened in June 2006 and is adjacent to the Maternity building.
The new Maternity unit is fully equipped for modern Maternity care. The Labour suite is divided into
Obstetric and Midwifery areas. Most patients in the Midwifery area deliver, recover and progress home
from the same room. The Maternity unit also has a modern ultrasound department, an out patient
clinic, and areas for acute receiving and day monitoring.
Patients with problems in early pregnancy are dealt with in the early pregnancy assessment suite in the
Maternity unit. There is also a suite for patients considering termination of pregnancy.
Ultimate responsibility for the care and treatment of patients within this unit rest with the Consultant
Staff.
There are 15 Consultants in Obstetrics and Gynaecology:
Consultants
Dr David Rae: Clinical Director –
Gynaecology and Sexual Health
Dr Jane Ramsay: Clinical Director Obstetrics
Dr Francis Inyang
Dr Inna Sokolova
Dr Gill Irvine
Dr Lucie Buck
Dr Sham Prasad Konamme
Dr Marjory Maclean
Dr Wael Agur
Dr Kirstyn Brogan
Dr Santanu Acharya
Dr Inass Osman
Dr Rita Panigrahy
Dr Vivian Franklin
Dr Sonal Anderson
Associate Specialists
Rekha Latoria
Ashraf Habib
Special Interest
Minimal Access Surgery
Urogynaecology
Maternal Medicine
Gynaecological Oncology
Urogynaecology
Postmenopausal bleeding service
Minimal Access Surgery
Menstrual Disorders/Outpatient Hysteroscopy
Minimal Access Surgery, Gynaecological Oncology,
Outpatient hysteroscopy
Early pregnancy problems, Recurrent miscarriage
Medical Education
Urogynaecology
Labour Ward – Lead Clinician, Multiple pregnancy
Subfertility
Fetal Medicine – Lead Clinician, Obs Ultrasound
Colposcopy – Lead Clinician
Antenatal Care; Emergency Gynaecology
OP hysteroscopy, Emergency gynaecology
Special Interest
Postmenopausal Bleeding Service
Obstetric Ultrasound/Pelvic floor surgery
There are also 7 middle grade staff, 1 research fellow, 1 teaching fellow, 1 sub fertility fellow, 2 or 3
ST1/2 doctors in obstetrics and gynaecology, 4 GPST2 doctors and 4 or 5 FY2 doctors working within
the department. Resident out of hours cover for gynaecology ward is provided by the hospital at night
team although there is a consultant available, on call from home.
DUTIES AND RESPONSIBILITIES OF THE POST
Obstetrics and Gynaecology have only been on one site since 23 August 2006. There are 14 doctors
who provide care at a junior level and provide out of hours cover for these specialities.
They will compose part of a team with the consultants and middle grade staff.
The 14 doctors comprise 5 on the foundation programme, 5 on a formal GP rotation.
A structured programme in place to meet the training needs of these different groups.
In Obstetrics it is hoped that the junior trainees will take an active role in the daily management of the
antenatal and postnatal patients under his/her Consultant’s supervision and to attend antenatal clinics,
ward rounds, decision making consultations in the Antenatal Assessment Unit and the Early Pregnancy
Assessment Suite along with his/her Consultant.
In Gynaecology the junior trainees are part of the ward team and will manage patients as part of the
team. Attendance is expected at the clinics, both the general Gynaecology clinics and the specialist
clinics in Infertility, cancer, Colposcopy, PMB, and Urogynaecology.
Training
A programme of regular teaching sessions are held, embracing both obstetric and gynaecology topics
as well as teaching ward rounds in gynaecology and clinical-pathological conferences in the Pathology
Department at University Hospital Crosshouse. There are weekly meetings exploring interpretation of
CTG traces, case presentation and Journal Club meetings co-ordinated by the most senior registrar, in
addition to weekly departmental meetings chaired by a Consultant. There are monthly perinatal
morbidity and mortality meetings. As a training grade doctor, you are encouraged to attend and
participate. There is a well established computer database for the collection and collation of
information.
There is a good library within University Hospital Crosshouse and teaching complexes both within
University Hospital Crosshouse and the Maternity Unit.
Conditions and Hours of Duty
This post is available immediately until 4 August 2015.
The working pattern is described as a full shift system within the Obstetric and Gynaecology Unit,
comprising of a basic 40 hour week (pensionable) attracting a non pensionable supplement at payband
1A (inclusive of prospective cover) within the gynaecology element of the Contract, and a non
pensionable supplement currently at payband 1A (inclusive of prospective cover) in the obstetric
element of the Contract, with control on hours as defined in the Terms and Conditions of Service.
FY2 doctors participate in the Hospital at Night (HAN) Team.
In addition to the annual leave entitlement as described in the Contract of Employment, there is an
entitlement to a maximum of 30 days per annum for the provision of study leave. Requests for study
leave should be authorised by the Clinical Director and passed to the West of Scotland Postgraduate
Board.
Normally, only one doctor is permitted leave, whether annual or study, at any one time and leave
should be arranged timeously.
The post is non-compulsory resident. It is the responsibility of the incumbent to ensure that he/she is
available by telephone and able to reach the ward in time to meet the clinical commitments when oncall.
Recognition of Post
This post is not recognised for educational purposes. However, you will be encouraged to make full
use of all of the training and educational opportunities available.
Further Information
Those candidates shortlisted can find out more about this opportunity or arrange an informal visit to
the unit by contacting Dr V Franklin, Consultant Obstetrician/Gynaecologist. Tel: (01563) 825430.
NHS Scotland
Application
-
Confidential –
Application for post of:
Location:
Post Ref No:
Closing Date:
Name
Personal
Information
Address
Email
Telephone
1 Medical education, any other professional degrees or qualifications, undergraduate
awards, prizes distinctions etc
Qualifications obtained (please state if part qualified) membership of professional institutions
Date from
Date to
Award, Degree, prize etc
2. Detail of current (or most recent) post
Job title:
Speciality:
Grade:
FY2
ST
FTSTA
LAT
LAS Other:
Employer:
Location:
Dates employment started and (if
applicable) finished:
From:
To:
Was this role a research post?
Yes
No
If yes, are you on an on-call rota?
Yes
No
If yes, how often and at what grade?
What proportion of your time is spent on clinical work?
Role and summary of duties
3. Other previous posts held since graduation from medical school
Please put in chronological order, and provide reasons for any gaps in employment.
Please also include details of previous, current and future employment you know of
together with details of your employer and a brief summary of your role.
Dates from
Dates to
4 Clinical Competence
Please highlight below the competences you have achieved that you feel are particularly
relevant to this application, e.g. procedures and to what level of competence, level of
involvement in acute take, clinical courses attended. Please refer to the relevant person
specification.
Max 200 words
5 Commitment to specialty
Please provide details as to what steps you have taken to show commitment to this
specialty (e.g., membership of societies, attendance at meetings, courses or exams
undertaken, taster placements, specific electives, etc.)
Max 200 words
6 Audit, research and presentations
Please detail what audit and/or research work you have undertaken, including details of
publications and presentations. Specify to what extent you initiated the work, undertook
and analysed it; if and how the audit loop was closed, type of meeting where any
presentation took place and publication format and journal.
NOTE do NOT give names in presentation or publication citations but list title,
journal/conference, date, volume and pages. Please indicate where in the authorship you
are (e.g. first, third author etc).
Max 300 words
7 Teaching and organisational activity
Please provide details of your involvement in teaching activities (including when, how and
formal/informal) and other work-related organisational activities (e.g. rota co-ordinator,
representative roles etc., including when and what this involved.)
Max 200 words
8 Leadership involvement
Please detail dates, type and level (local / national; senior / junior; school / university) of any
experience you have of leadership roles in either medical or non-medical fields, e.g. team,
organisation or group leader. Explain how this is relevant to your application.
Max 200 words
9 Personal achievements and qualities
Please detail non-medical activities you have undertaken and how they demonstrate your
personal qualities (e.g. volunteer work, sporting & performance arts activities): Specify
dates, your role (member / leader) and the level (junior / senior: local / national). Please
also highlight how these achievements and qualities enhance your approach to medicine.
Max 200 words
10 Personal statement in support of your application
Please tell us in, why you wish to apply for this post and highlight the experience you have
gained relevant to this position.
Additional Information may be obtained from the following links:
NHS Ayrshire & Arran Web site: www.nhsaaa.net
Living & Working in Scotland: http://www.scotmt.scot.nhs.uk/living-in-scotland.aspx
Web Sites of Interest for Candidates
Scottish Health on the web Scottish Executive Local Government Councils -
www.show.scot.nhs.uk
www.scotland.gov.uk
www.east-ayrshire.gov.uk
www.south-ayrshire.gov.uk
www.north-ayrshire.gov.uk
Ayrshire and Arran Tourist Board www.ayrshire-arran.com
Useful Reading:
The following documents can be obtained via the SHOW website by accessing Publications:
“Our National Health – A plan for action, a plan for change” sets out a clear statement of national
priorities for health and the NHS in Scotland.
“Rebuilding our National Health Service” this document provides guidance to the service on the
implementation of the policies as set out in “Our National Health – A plan for action, a plan for
change”
Local Health Plan within the Ayrshire and Arran Health Board website – publications.