Workforce Directorate NHS Tayside Ninewells Hospital Level 9 DUNDEE DD1 9SY Telephone Number (01382) 660111 Fax Numbers (01382) 632098 & 496237 www.nhstayside.scot.nhs.uk Date As Postmark Your Ref Our Ref FS/03/12 Enquiries to Miss Fiona Small Extension 34186 Direct Line 01382 660111 ext 34186 Email firstname.lastname@example.org Dear Doctor POST OF CONSULTANT IN CHILD & ADOLESCENT PSYCHIATRY Further to your enquiry regarding the above post, I am now pleased to enclose an information and application pack. Your application should be submitted to this department in the form of the following documents: your completed Immigration Status Form and a *photocopy of your passport/current immigration status documents – NB British and EEA Nationals must also enclose a photocopy of their passport to verify nationality 8 copies of your CV, including the names and addresses of 3 referees, including your current or most recent employer. It would also be helpful if you could include details of your registration on the Specialist Registrar of the General Medical Council or your expected date of completion of training. your completed Declaration Statement in respect of Fitness to Practice and Criminal Convictions Please quote FS/03/12 when submitting your application. *Please be aware that failure to enclose documentation confirming your current immigration status will result in your application being rejected. As an Equal Opportunities Employer, it is NHS Tayside’s policy to ensure that all applicants are given the same consideration in relation to job selection, promotion and treatment. In this connection, I enclose an Equal Opportunities Form which you should return to this office with your application. This information is for statistical purposes only and will be kept in strict confidence. The closing date for receipt of completed applications is Monday 9 April 2012. Interviews are scheduled for Monday 30 April 2012. Owing to the number of applications received and to make the best use of resources, we are unable to acknowledge receipt of applications. Yours faithfully Fiona Small Workforce Services Adviser Encs MEDICINE DIRECTORATE CONSULTANT CHILD AND ADOLESCENT PSYCHIATRIST Applications are invited for this whole time post as Consultant for the Tayside CAMHS Outpatient services. Applicants with experience in risk assessment in children and adolescence would be well placed to meet the current service requirements. Tayside CAMHS provides a comprehensive mental health assessment and treatment service for children and young people from birth up to the time they leave school. The service operates with a multidisciplinary, multi-agency ethos and has strong links with the local authorities and the voluntary sector. The CAMHS service is a dynamic, forward-looking service with strong links to the University of Dundee, with an active interest in teaching and research. The clinical service has undergone considerable redesign in the past few years and now have a comprehensive range of integrated services with an experienced and highly motivated workforce. Multi-disciplinary teams have a strong commitment to evidence based practice and to teaching and training. Comprehensive outpatient services are complemented by a team of Primary Mental Health Workers, a Day Service for 5-14 year olds and a small Adolescent Inpatient Unit. Outpatient services are currently delivered from two outpatient bases, one in Dundee and one in Perth. Strong links are maintained with local authorities, the voluntary sector and Adult Mental Health Services. Applicants must be on the Specialist Register or be within 6 months of the anticipated award of CCT in psychiatry or CESR(CP) at the time of interview for the post. This post is open primarily to applicants who do not require to be sponsored under the the UKBA Points Based System. Applications from applicants who do require sponsorship will be considered only if no suitable UK/EEA national or anyone not requiring sponsorship is identified for the post. For further information or enquiries please contact Dr Judith Piggot, Clinical Lead, Consultant Child and Adolescent Psychiatrist tel. 01382 204004. Applicants can also contact Dr Peter Fowlie, Clinical Director, Ninewells Hospital, tel 01382 660111. To download further particulars about the post, please visit www.bmjcareers.com or www.jobs.scot.nhs.uk. Applications in the form of 8 copies of a current CV, including names and addresses of 3 referees, should be forwarded to Workforce Directorate, Level 9, Ninewells Hospital, Dundee, DD1 9SY or to email@example.com. You must include the further particulars forms available at the above websites. Please quote reference number – FS/03/12 Closing date for receipt of completed application forms – Monday 9th April 2012 Interviews are scheduled to take place on Monday 30th April 2012. NHS TAYSIDE JOB DESCRIPTION Consultant Child and Adolescent Psychiatrist 1. INTRODUCTION Applications are invited for this whole time post as consultant for the outpatient Tayside CAMHS Service. Applications for part time working will be considered. This is a replacement post which has become available following one of the current consultants moving to consultant post in Young Peoples Unit. Clinical responsibility will be within the CAMHS outpatient service. This post is available immediately. Tayside CAMHS is based primarily within a campus clinic base in Dundee with a satellite clinic in Perth and satellite clinics in Angus. The service is part of the Women and Child Health Clinical Group within the Acute Delivery Unit of NHS Tayside. Through the Child Health Strategy Group it has strong links with statutory and voluntary services, across 3 local authority areas, which are concerned with providing care for children and young people. NHS Tayside serves a population of approximately 394 000. Tayside CAMHS provides comprehensive mental health assessment and treatment services for children and young people from birth up to the time they leave school. The service operates with a multidisciplinary, multi-agency ethos and has strong links with the local authorities, the voluntary sector and the University of Dundee. Currently we are in the process of implementing CAPA with training for staff planned and this is expected to influence the model of service delivery within Tayside. Dundee with a population of around 170,000 is the principal city in Tayside and is situated on the north bank of the River Tay. It is conveniently near the three other large cities in Scotland - Edinburgh, Glasgow and Aberdeen, none more than an hour and a half away by road or rail, and London is just six hours away by Intercity rail link and less than two hours by air. Perth, known as “the Fair City,” is located at the very heart of Scotland. Perth’s status as former capital of Scotland has given it a wealth of historical associations and a centuries-old tradition of welcoming visitors. It is the regional centre for the predominantly rural county of Perthshire and Kinross. The population is increasing, and several international companies have their headquarters in Perth. Between Dundee and Perth there is a flourishing professional repertory theatre and regular visits by the Royal Scottish National Orchestra add an extra dimension to what is an active local musical scene. The river and its estuary, the coasts of Angus and Fife and the nearby hills and mountains of Angus and Perthshire offer scope for almost any outdoor activity. Golfers are particularly well served with St. Andrews and Carnoustie within half an hour's drive. Hillwalkers, skiers and fishermen fair equally well. There is a good range of relatively inexpensive housing in Tayside. 2. SERVICE DESCRIPTION Outpatient Services Tayside CAMHS operates out of two main clinic bases one in Perth and one in Dundee. The Centre for Child Health is a modern purpose-built clinic shared with Speech & Language Therapy. It is part of a campus-based service in the centre of Dundee that is also home to the Day Service and Young People’s Unit. This excellent facility provides office and therapy space within a park setting and caters mainly for patients from Dundee and Angus. Pitcullen House, in the grounds of Murray Royal Hospital in Perth, provides services for patients from Perth & Kinross. It is an old Victorian building. This clinic will be re-sited in the near future as part of the hospital development plans at Perth Royal Infirmary. There are currently no fixed out-patient clinical services based in Angus. However discussions are ongoing to facilitate the delivery of clinical services in Angus. Tier 3 outpatient services are organised into two pan-regional teams with staff working to care pathways and protocols across the whole area. The outpatient teams are: 1. Developmental Disorders Team Sees patients with attention deficit/hyperactivity disorder, moderate to severe learning disability, autism spectrum disorder, Tourette’s, etc. 2. Emotional Disorders Team Sees patients with mood or anxiety disorders, eating disorders, deliberate self-harm, post traumatic stress disorder, psychosis etc. Two emergency response team nurses are attached to the EDT and provide week day cover for self-harm and other psychiatric emergencies. Both teams in the outpatient service work across a variety of therapeutic modalities and have staff trained to a high level in psychopharmacology, Systemic Practice, Cognitive Behavioural Therapy and Behavioural Therapy. Day Service A day service for P1-S2 pupils operates out of Dudhope House and provides an assessment service and a group-based intervention programme for children aged 5-14 years. Young People’s Unit This inpatient unit for adolescents aged 12 and up currently operates 6 beds. Within the framework of the National Implementation Plan, discussions are underway with the North of Scotland Planning Group (NoSPG) to commission a new 12 bed regional unit in Tayside. Initial agreement to proceed with this has now been approved by the Scottish Government. 3. THE POST Employing Authority NHS Tayside Grade Consultant Specialty Child and Adolescent Psychiatry 4. PLACE OF WORK Outpatient clinical work will be conducted both within the Centre for Child Health and at other clinical sites within Tayside (e.g. in Perth and Angus). The main base for the post holder will be Dudhope Centre for Child development, Dundee. Appropriate travel time will be incorporated into the job plan. 5. CONTRACT 10 PAs The post holder will share on call with 8 other consultant colleagues. 6. PRINCIPLE DUTIES This is a replacement post. The main duties associated with this post will be to provide assessment and clinical care for children and adolescents in Tayside with emotional and developmental disorders. The outpatient teams currently provide services for children and young people from birth up to the time they leave school. Duties will include direct clinical work with an appropriate caseload, consultation with other agencies, supervision of staff (this will include junior medical staff and but may also include nurses, both trained and training clinical psychologists, occupational therapists and other associated medical specialists), attending team meetings and taking part in the planning of service delivery. The precise job plan for the new post holder, depending on training, experience and interests will be influenced by wider developments e.g. implementation of CAPA across the service and provision of non inpatient tier 4 services. The department is moving towards a CAPA based service, and it is anticipated that all the outpatient consultants will move to working predominantly in one of the three locality teams (Perth, Angus and Dundee). The post holder will also have an interest in managing more complex cases where there is a combination of mental illness/developmental disorders and offending. This will involve working with young people in the Rossie Secure Accommodation in Montrose and taking a lead role in developing risk assessment within Tayside CAMHs. Rosie Secure Accommodation has places for up to 18 young people, aged 10-16. There is currently no dedicated CAMHs service for Rossie and they are seen throughout the department depending on their clinical need. The post holder will work alongside existing CAMHs staff, including the wider consultant group, to take a lead in ensuring the clinical needs are met. There are national discussions taking place with Graham Monteith, CAMHs nurse advisor for Scottish government, related to mental health input to children’s secure units. Developmental Disorders Team Staff: 3.2 WTE Consultant Child and Adolescent Psychiatrists 4.4 WTE specialist nurses (band 6) 2.8 WTE learning disability nurses 1.7 WTE Clinical Psychologist Family therapist (part time) 0.5 WTE Specialty Trainee 1-3 0.4 WTE Staff Grade Psychiatrist (based in Perth)1.4 WTE Staff Grade Paediatrician attached from Community Paediatrics (1.3 WTE in Dundee, 0.1 WTE in Perth Emotional Disorders Team Staff 2.5 Consultant Child and Adolescent Psychiatrists 2 WTE specialist nurses 2.8 WTE psychologists 1 CBT specialist Family therapist (part time). 2 WTE emergency response nurses 1 WTE Foundation Year 2 doctor On Call Consultant on call is supported by cover from ST 1-3 doctors from psychiatry providing emergency services for Tayside. Research and Audit The service has links with the University of Dundee, Section of Psychiatry within the Centre for Neuroscience and is highly active in research, particularly in the areas of Attention Deficit/Hyperactivity Disorder and paediatric psychopharmacology. There is an active Clinical Governance Working Group within the service and all members of staff are encouraged to undertake and/or supervise audit. Continuing Professional Development NHS Tayside is committed to supporting Continuing Professional Development and all consultants are expected to have a Personal Development Plan developed within a peer group system. Up to date Child Protection Training is required. 7. JOB PLAN The job plan will be agreed between the successful candidate and an appropriate medical manager – Clinical lead for CAMHS, Clinical Director for Women and Child health or the Associate Medical Director for Medicine. The job plan will be reviewed annually. The following weekly timetable is indicative only. While initially the post holder will have minimal formal managerial and teaching duties, reflected in the SPA allocation below, it may be appropriate for the DCC/SPA to be adjusted by agreement at subsequent job plan review meetings. The job plan will be split 9 DCC: 1SPA. DAY LOCATION WORK DONE Monday am Centre for Child Health Indirect clinical work – consultation, school liaison, etc pm Centre for Child Health or Outpatient clinic other clinical site in Tayside Tuesday am Centre for Child Health Clinical admin pm Centre for Child Health or Outpatient clinic other clinical site in Tayside Wednesday am Centre for Child Health or Outpatient clinic other clinical site in Tayside pm Centre for Child Health SPA – Division/in-house teaching/medical staff meeting/CPD Thursday am Centre for Child Health / Team meeting and staff supervision Perth pm Centre for Child Health Outpatient clinic Friday am Centre for Child Health or Assessment of complex patients (high risk CAMHS cases) other clinical site in Tayside pm Centre for Child Health Clinical admin Support Services Appropriate secretarial time and office space is available to support this post and the associated multidisciplinary clinical team. Secretarial support will come from the relevant teams, and there will also be an identified secretary to assist the post holder with non-clinical administrative tasks. 8. PHYSICAL RESOURCES Appropriate office space will be available for the post holder’s use. The office space will be shared, as is the case with all current consultant office space. A variety of clinical rooms are available on a bookable basis at both the Centre for Child Health and Pitcullen House, including one-way screening facilities and a Snoozelen room. IT facilities will also be available. Within the Centre for Child Health there is an excellent Seminar Room equipped with PowerPoint, video linking, etc, which is bookable for meetings of up to 50 people. There is a Reading Room with a good range of reference books, journals and internet access. 9. THE SERVICE Tayside has a population of approximately 394,000, of which 142,000 live in Dundee, 110 000 live in Angus and 142 000 live in Perthshire. The current consultant complement is 6.6 WTE (increasing to 7.6 when all new staff are in post) clinical posts with an additional 6 sessions of academic time provided by the Senior Lecturer. The outpatient teams are tier 3/4 services that see children with anxiety disorders, mood disorders, eating disorders, psychosis, post-traumatic and adjustment difficulties within the Emotional Disorders Team and attention deficit hyperactivity disorder, autistic spectrum disorder, Tourette’s and moderately and severely learning disabled children with a psychiatric problems within the Developmental Disorders Team. Tayside CAMHS is represented on NHS Tayside’s Child Health Strategy Group with good links to the Child Health Commissioner. A needs assessment and recent nationally commissioned audit reports have highlighted the difficulties faced by the service with demand outstripping supply and the service is working actively to improve this situation, reduce waiting times and expand services for patients. Several new posts have been funded to facilitate the first stages of this process. In addition a service development plan that has proposed substantial increases in funding for CAMHS is currently being considered by the NHS Tayside Board. Tayside CAMHS is managed by a local service team within the Women & Child Health Clinical Group, which is part of the Medical Directorate within the NHS Tayside Delivery Unit structure. The Lead Clinician for Tayside CAMHS represents the service on the Women & Child Health Executive Group and, alongside the Clinical Nurse Manager, has day-to-day managerial responsibility for the service. Women & Child Health has a full-time Clinical Director and at service and directorate level there is support from Finance, Human Resources, Administrative & Clerical Management Services and Pharmacy. The current Clinical Director is Dr Peter Fowlie, Consultant Paediatrician. Paediatric services in Tayside are provided by the Delivery Unit through the Paediatrics Directorate, part of the larger Women & Child Health Clinical Group. There are both community and acute services. Acute services are based primarily at Ninewells Hospital in Dundee with a small unit at Perth Royal Infirmary. Community Services serve all 3 local authority areas in Tayside and operate from sites in Perth, Angus and Dundee. The 3 local authorities of Angus, Dundee City and Perth & Kinross operate statutory social work and education services and Dundee City, through the Child Health Team, provides social work services for CAMHS patients. There are residential social work services for young people in all 3 areas and a small close support unit, The Elms, in Dundee. Medical Staff Consultants Dr D. Coghill Developmental Disorders Team 0.6 WTE Reader (University of Dundee)– academic sessions 0.6 WTE Dr S. Duke YPU/Day Service 1.2 wte Regional Advisor for Psychiatry Dr J. Olver Emotional Disorders Team 0.7 WTE Acting Training Programme Director Dr S. Seth Developmental Disorders Team 1.0 WTE (0.6 WTE) Dr J. Piggot Developmental Disorders Team 1.0 WTE Dr J. Graham Emotional Disorders Team 1.2 WTE Dr E. Skouta Emotional Disorders Team Team 0.6 WTE Dr Naomi McCaig Developmental Disorders Team 0.6 WTE Specialist Registrars/Specialty Trainees Dr H Smith ST5 Staffing within CAMHS Primary Mental Health Workers 1 WTE Team Leader 7.5 WTE Band 6 for Tayside Day Service 7.6 WTE Nurses 1.6 Clinical Support Workers Young People’s Unit 22 WTE Nurses 4 Clinical Support Workers Speech and Language Therapist Dietician Physiotherapist Art Therapist Nursery Nurses 1 WTE nursery nurse for waiting patients in Dundee 1 WTE nursery nurse for waiting patients in Perth Outpatient nursing staff 7.2 WTE Clinical Psychology Staff Dr S. Macdonald 1 WTE Consultant Clinical Psychologist/Lead Clinician Dr D. Stuart-William 0.6 WTE Consultant Clinical Psychologist (YPU) 6.6 WTE Clinical Psychologists 5 Trainee Clinical Psychologists Occupational Therapy Staff 2 WTE Senior I 1 WTE Senior II – Head of Service Teaching Staff Day Service/Young People’s Unit 3 WTE teaching staff funded by Dundee City Council Administrative & Clerical Staff Developmental Psychiatry Team (Dundee) 4 WTE Clinical Team Secretaries Emotional Disorders Team (Dundee) 1 WTE Clinical Team Secretary Management 1 WTE Management Secretary Day Service 1 WTE Clinical Team Secretary Primary Mental Health Team 0.6 WTE Team Secretary Perth 1 WTE Clinical Team Secretary Young People’s Unit 1 WTE Clinical Team Secretary 1 WTE Receptionist based at the Centre for Child Heath 1 WTE Senior Clerical Officer (Medical Records) based at the Centre for Child Health Social Work 2 social workers funded by Dundee City Council. 10. The University of Dundee The medical school was originally part of the University of St. Andrews, but became the Faculty of Medicine of the University of Dundee when the latter received its Charter in 1967. The present annual intake of medical students is 150 and the total number of students at the University is 11,000. The University is also a centre for medical education and research. The University of Dundee enjoys an international reputation for research excellence in the Biomedical Sciences. Excellent opportunities exist for the conduct of clinical research, including structural and functional neuroimaging, within the Clinical Research Centre at Ninewells Hospital in Dundee. The University has an excellent track record for child and adolescent psychiatry research. The main research focus is on ADHD, conduct disorders, depression and paediatric psychopharmacology. Current research projects include neuropsychological studies, clinical trials, genetics and pharmacogenetics, quality of life. The current academic staffing in the Section of Psychiatry and Behavioural Sciences consists of three Professors, Keith Matthews (Head of Section and Deputy Head of Division, Honorary Consultant Psychiatrist), Douglas Steele (Professor of Neuroimaging and Honorary Consultant Psychiatrist) and David Balfour. Professor Balfour is a non-clinical professor of neuropharmacology. David Coghill is Reader in Child and Adolescent Psychiatry. There are four Clinical Senior Lecturers (General Adult Psychiatry - Richard Day, Addiction Psychiatry - Alex Baldacchino and Brian Kidd, Old Age Psychiatry - Neil Prentice, ), one Teaching Sub-Dean (ACT funded) – Audrey Morrison and one Clinical Lecturers (Cognitive Behavioural Psychotherapy – John Swan, with one non-clinical Lecturer in Neurobiology - Caroline Stewart. There are a number of post-doctoral research staff and graduate students. Research in Psychiatric and Behavioural Neuroscience covers 3 major topics: Addictions, Affective Disorders, and Development & Neurodegeneration. Major funding support for the activities of the Section has come from the MRC, the Wellcome Trust, The Alzheimer’s Research Trust, the Scottish Government Health Department’s Chief Scientist’s Office, the European Union and industrial partners. The Section makes major contributions to the delivery of the Dundee undergraduate medical and life sciences curricula (medicine was rated "excellent" in the most recent Teaching Quality Assessment). NHS consultant medical colleagues are offered honorary academic appointments as Senior Clinical Tutors in Psychiatry. Honorary status as a Clinical Senior Lecturer may be conferred at the discretion of the Dean. Further details of Departmental activities and contact details can be found at http://www.dundee.ac.uk/medschool/medsci/neuroscience/clinical-behaviour/ 11. CONDITIONS OF SERVICE The appointment will be for 10 programmed activities per week. The salary of the appointment is subject to the Terms and Conditions of Service for the Consultant Grade in Scotland. Salary range £74,504 to £100,446 per annum (from 1 April 2009). Candidates must hold GMC registration with a licence to practice. Applicants must be on the Specialist Register or be within 6 months of the anticipated award of CCT or CESR(CP) at the time of interview for the post. The appointment will be subject to the Terms and Conditions of Service of the Consultant Grade (Scotland) and the General Whitley Council Conditions of Service as amended from time to time (and any reference in those Terms and Conditions to an employing authority shall be construed as if it were to include a reference to NHS Tayside). Membership of the NHS Superannuation Scheme is not compulsory, but all medical and dental staff are entitled to choose if they wish to join the scheme. Until such time as a positive option not to join the scheme is expressed, a member of staff will be regarded as a member of the scheme from the first day of service. This will not affect any individual right to make alternative arrangements. Initially the employment covered in this contract will be contracted out of the State Pension Scheme. The successful candidate will be expected to reside within an approved distance of Centre for Child Health, Dundee. 12. RESPONSIBILTY FOR RECORDS MANAGEMENT All records created in the course of the business of NHS Tayside are corporate records and are public records under the terms of the Public Records (Scotland) Act 1937. This includes email messages and other electronic records. It is your responsibility to ensure that you keep appropriate records of your work in NHS Tayside and manage those records in keeping with the NHS Tayside Records Management Policy and with any guidance produced by NHS Tayside specific to your employment. 13. FURTHER INFORMATION For further information or enquiries please contact Dr. Judith Piggot, CAMHS Clinical Lead, Consultant Child and Adolescent Psychiatrist, on telephone number 01382 204004. Applicants can also contact Dr Peter Fowlie, Clinical Director, and/ or Dawn Sturrock, Clinical Services Manager, Women and Child Health Clinical Group, Ninewells Hospital, telephone number 01382 660111. 14. APPLICATIONS Applications in the form of 8 copies of a current CV, including names and addresses of 3 referees, should be forwarded to Workforce Directorate, Level 9, Ninewells Hospital, Dundee, DD1 9SY or to firstname.lastname@example.org. You must include the further particulars forms available at the above websites. Please quote reference number – FS/02/12 SHORTLISTING CRITERIA FOR APPOINTMENT OF CONSULTANT MEDICAL AND DENTAL STAFF The Board is committed to the principle of equality of opportunity in employment and accordingly its advertising and recruitment literature will not imply that there is a preference for any one group of applicants, e.g. by the use of discriminatory job titles or material depicting or describing certain sexual or racial groups. In general the short-listing process will be conducted so as to give all candidates equal consideration against defined selection criteria. The following criteria will therefore be applied equally to all candidates irrespective of age, sex, religion, ethnic origin or disability and avoiding judgements on the basis of assumptions or stereotypes. POST: CONSULTANT IN CHILD AND ADOLESCENT PSYCHIATRY CRITERION EXPECTED MINIMUM 1. Length of Service/ E Minimum of 3 years higher training in Psychiatry Training 2. Qualifications E MRC Psych or equivalent Accreditation by relevant E Completion of Specialist Registrar Training and inclusion on committee the GMC specialist register or within 6 months of CCT E Appropriate Mental Health Act experience. D Appropriate experience working with the Adults with Incapacity Act. 3. Advanced clinical training E Broad knowledge of psychiatric disorders in childhood and and experience their management E Specialist experience in the assessment and management of developmental disorders in children and adolescents. D Specialist experience managing complex cases and risk assessment D Specialist training in one or more psychological treatment modalities an advantage. 4 General experience E Evidence of good multidisciplinary team working E Knowledge and experience of working with education, social work and youth justice systems E Child protection training 5 Particular requirements E Full GMC Registration and/or areas of special interest 6 Research and D Research experience and publications publications 7 Management Training E Basic management experience to provide leadership to multidisciplinary clinical team NOTE: Criteria marked with an "E" have been identified as essential for the post concerned. APPOINTMENT AND REVIEW PROCEDURES Declaration Statements and Statements of Policy Statement of Policy regarding fitness to practise proceedings by a licensing/regulatory body and relating to criminal investigations in the UK or overseas. Registration with the General Medical Council or General Dental Council imposes on doctors and dentists the duty to provide a good standard of medical care for, and to behave appropriately, towards patients. NHS Employers also have a duty to ensure that patients receive a good standard of medical care and ensure as far as possible the safety of patients. We therefore need to establish if you have been found guilty of a criminal offence, been bound over or cautioned or are currently the subject of proceedings which might lead to a conviction, an order binding you over or a caution, in the UK or any other country. Applicants for posts in the NHS are exempt from the Rehabilitation of Offenders Act 1974. Application forms will include a declaration for applicants to complete declaring any previous or pending prosecutions or convictions, including those considered ‘spent’ under this Act. Forms will also include a declaration of any cautions or bind overs. We also need to establish if you have been the subject of any fitness to practise proceedings in the past, or any fitness to practise proceedings are being contemplated, by a licensing or regulatory body in the UK or another country and this is also reflected in the declaration. This information will be treated in confidence and will not debar you from appointment unless the selection panel considers that it renders you unsuitable for appointment. In reaching such a decision we will consider the nature of the conviction/action, how long ago it took place and any others factors that may be relevant. Failure to disclose a criminal offence, having been bound over or cautioned or that you are currently the subject of criminal proceedings which might lead to a conviction, an order binding you over or a caution, or fitness to practise proceedings undertaken or being undertaken by an appropriate licensing or regulatory body, may disqualify you from appointment, or result in summary dismissal/disciplinary action and referral to the General Medical Council [General Dental Council] for consideration if such a discrepancy came to light. If you would like to discuss what effect any previous convictions, police investigations or fitness to practise proceedings taken or being taken either in the UK or by an overseas licensing or regulatory body might have on your application, you may telephone the Employment Services Adviser, Medical Staffing, on 01738 473302, in confidence, for advice. Model Declaration Statement regarding Formatted: Font: Not Bold (a) any criminal offence, being bound over or cautioned, or current proceedings which might lead to a conviction, an order binding you over or a caution and (b) fitness to practice proceedings taken or being currently contemplated by a licensing/regulatory body 1. Have you been convicted of a criminal offence, been bound over or cautioned or are currently the subject of any police investigations, which might lead to a conviction, an order binding you over or a caution in the UK or any other country? YES/NO Note: Applicants for posts in the NHS are exempt from the Rehabilitation of Offenders Act 1974. You are required to declare prosecutions or convictions, including those considered ‘spent’ under this Act. If yes, please provide details of the criminal offence, order binding you over or caution or details of any current proceedings which might lead to a conviction, an order binding you over or a caution, including approximate date, the offence, and the authority and country which dealt with the offence. 2. To the best of your knowledge have you been or are you currently subject to any fitness to practise proceedings by an appropriate licensing or regulatory body in the UK or any other country? YES/NO If yes, please provide details of the nature of proceedings undertaken, or contemplated, including approximate date of proceedings, country where proceedings were undertaken and the name and address of the licensing or regulatory body concerned. I hereby declare that the information given here is true. Signature:______________________________________________ Date:__________________________________________________ NHS TAYSIDE EQUAL OPPORTUNITY MONITORING FORM Job reference number: FS/03/12 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 is confidential and is not used in the selection process. It will be separated from the rest of your application 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: 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? Yes No Prefer not to say If you answered ‘yes’ please tick if it is either of the following: Learning Disability Physical impairment Long standing illness Sensory impairment Mental health condition Other (please describe): Again, if yes, please describe any particular arrangements you would need for your work location: (Continued on next page) - 2- Job reference number: FS/03/12 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 Polish Gypsy Traveller Any other White background B: Mixed Any mixed background C: Asian; Asian Scottish; Asian British Pakistani Indian Chinese Bangladeshi 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 Thank you. equaloppsmonform IMPORTANT NOTICE IMMIGRATION STATUS Please be aware that all job applicants, including British and EEA nationals must enclose photocopies of their passport (outside front cover, page containing personal details and resident permit/visa stamps). If you have been issued with a Biometric Residence Permit, a photocopy (front and back of card) must also be enclosed. Shortlisted applicants will be required to bring their original documents with them, for inspection, when attending for interview. 1 Are you a national from Austria, Belgium, Cyprus, YES NO Denmark, Finland, France, Germany, Greece, Iceland, Ireland, Italy, Liechtenstein, Luxembourg, Malta, Netherlands, Norway, Portugal, Spain, Sweden, United Kingdom or Switzerland? 2 Are you a national from the Accession States (A8 YES NO Countries) – Czech Republic, Estonia, Hungary, Latvia, Lithuania, Poland, Slovakia or Slovenia? 3 Are you a national from the Accession States (A2 YES NO Countries) – Bulgaria and Romania? If you have circled ‘NO’ to the above sections please tick the box which relates to your current immigration status, and provide expiry dates: Status Tick Expiry Date I hold a Tier 1 (General) Visa as a highly skilled worker I require a Certificate of Sponsorship I hold refugee status I have indefinite leave to remain in the United Kingdom I have right of abode Any other immigration status – please specify: Print Name: …………………………………......................... Signature:……………………………………………………. Date: ………………………………………………………….
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