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					Council’s Officer
Application form
June 2011

This form is to be accompanied by:
Recruitment Monitoring Form

SECTION 1 of 7: Personal details
Surname:                                    Forename(s):

Address:                                    Telephone number:

                                            Mobile number:

                                            Email address:

SECTION 2 of 7: Declaration

To the best of my knowledge and belief the information given in this form is correct. I understand
that if I am appointed and this information is inaccurate, I am liable for dismissal.

Signature:                                            Date:

Please tell us where you heard about this vacancy:
   NMC Website                                                Other (Specify),

                                                                                        Page 1 of 4
Council’s Officer                                                             For NMC use only
Application form                                                              Applicant:
June 2011

 SECTION 3 of 7: Abilities and experiences
 Having familiarised yourself with the job description and person specification for this role,
 please give us about two or three examples on your ability/experience in each of these areas.
 Qualified to degree level or equivalent or relevant substantive vocational experience:

 What is your experience of delivering a high quality service to customers – internal or
 external to your organisation? How did you measure success?:

 Describe a time when you have had to manage relationships between multiple stakeholders
 to ensure the smooth running at a meeting:

 Describe a time when you have had to plan and prioritise conflicting requirements and meet
 tight deadlines:

                                                                                   Page 2 of 4
Council’s Officer                                                                 For NMC use only
Application form                                                                  Applicant:
June 2011

 Describe a time when you needed to use diplomacy and tact to deliver a difficult message
 whilst maintaining relationships in a tension-filled situation:

 LIST your Management/administrative experience in a regulatory body or similar

 SECTION 4 of 7: Entitlement to work in the UK
 In order to comply with the Asylum and Immigrations Act 1996 we are required to ask you to verify
 your entitlement to work in the UK
 Are you legally entitled to work in the UK?
                                                                                  yes            no
 Do you need a visa or work permit to work in the UK?
                                                                                  yes            no
 If Yes please give details including expiry date and any restrictions:

 SECTION 5 of 7: Criminal convictions
 Have you ever been convicted of a criminal offence? (Declaration subject to
                                                                                  yes           no
 the Rehabilitation of Offenders Act 1974)
 If yes please give details:

 SECTION 6 of 7: Current salary
 Please state your current or most recent salary:

                                                                                        Page 3 of 4
Council’s Officer                                                                For NMC use only
Application form                                                                 Applicant:
June 2011

 SECTION 7 of 7: References
 Please provide below your two most recent employment details. References will only be collected
 for successful applicants and with your consent.
 Reference 1                                      Reference 2
 Employment dates:                                Employment dates:
 Company name:                                     Company name:
 Company full address:                             Company full address:

 Telephone number:                                 Telephone number:
 Email address:                                    Email address:
 Contact name:                                     Contact name:
 Contact job title:                                Contact job title:

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