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					Dear Applicant

Application to a Dental Foundation Year 2 Posts

Thank you for applying to a training programme in the London Deanery. This letter explains the
appointment process we use.

This enclosed pack contains:

a)   a description of the DFY 2 posts (available to download on the London Deanery website)
b)   a person specification which describes the attributes for which we are looking. This is based
     around the GMC's document "Good Medical Practice". Please note that you must be able to offer
     all of those attributes described as essential if you are to be considered for short-listing and/or
     appointment;
c)   an application form;
d)   a short-listing scoring form (for information only) which will show you how the short-listing
     committee will judge your application against the requirements of the person specification.

Please read this pack carefully. As you fill out the application form you are advised to answer the
questions and complete the form with reference to the person specification. Please note:

         CVs and additional pages will not be accepted and therefore the application form should be
          fully and carefully completed.
         when completing the application form, you must not make any adjustments to the
          spaces allowed for the responses.
         the minimum type size which can be used is 10 point.
         failure to comply with the above instructions will result in your application being rejected
         the number of applicants called for interview will depend both on the number of the vacancies
          in the programme and on the short-listing scores achieved by applicants during this
          recruitment.
         the interview process will explore those areas included in the specification about which we
          need further information.
         please return the completed application form by email to:
           2009E2DentalFoundation2@londondeanery.ac.uk

         reference number : 061/40

         closing date : 06 November 2009 at 12 noon GMT. Late applications will not be accepted.

         interviews will be held on: 2nd / 3rd December 2009

         for further information about this training programme and visiting arrangements (shortlisted
          candidates only), please refer to the contact numbers given in the prospectus.

Professor Elisabeth Paice MA FRCP
Dean Director of Postgraduate Medical & Dental Education
         please let your referees know that you are applying for this post, so that if you are shortlisted,
          they will be prepared to respond to our reference request.

         successful applicants should be aware that changes could occur during the progression of the
          training programme. The principal aim will always be to deliver the best quality training
          experience.

         applicants need to be aware that although trainees‟ preferences are considered when making
          decisions on placements, final decisions take into account the service needs of all sites within
          our training programmes.


Thank you for applying to this training programme. Good luck with your application.

Yours sincerely




Jenny Byatt
Medical Recruitment Administrator




Professor Elisabeth Paice MA FRCP
Dean Director of Postgraduate Medical & Dental Education
                                       ***Important information***

                       It is essential that all applicants read this page.



Dear Applicant,

Thank you for your interest in this training programme. The application form is enclosed.
It is essential that you give careful thought to your answers and complete each section accurately. Please note that
you may be asked to provide evidence to support the statements you have made in any part of your form.
Please pay particular attention to the following and complete the corresponding sections in the application form as
appropriate:

Visa status - International Medical Graduates
On 7 March 2006 the Home Office announced changes to the immigration rules which have an affect on
Postgraduate Doctors and Dentists and which we must take into account during our current recruitment activity.

From 7 March we have to recruit doctors and dentists from the UK and the EEA (including those doctors and
dentists who have been accepted onto the Highly Skilled Migrant Programme) before we recruit migrant doctors
and dentists from outside EEA countries However, if there are posts available on any of the London Deanery
Training Programmes and no doctor or dentist with permanent residence or HSMP status in this country is able to
take up the post, fully trained international medical graduates with the appropriate qualifications may also be
considered for appointment. (Please see A Points-based System: Making Migration Work for Britain, pages 1 and
8)

The above statements represent our current understanding of the affects of the changes. For further information
regarding the new immigration strategy please contact the Home Office's Immigration and Nationality Enquiry Bureau
on telephone: 0870 606 7766 or by e-mail: indpublicenquiries@ind.homeoffice.gsi.gov.uk

Fitness to Practise
When completing that part of the application form headed “Fitness to Practice and Criminal Investigations”, you
should note that all doctors are exempt from the Rehabilitation of Offenders Act and you are therefore required to
complete the section at the back of the application form which relates to your Fitness to Practise status.
If you have any queries about any of the statements in this section please do not hesitate to contact the Medical
Workforce Department at the London Deanery as stated in the Fitness to Practise section. Any query you may
have will be treated confidentially.

Criminal Records Bureau checks (CRB)
CRB checks are carried out by the employing Trust in accordance with the guidelines set out by NHS Employers
(http://www.nhsemployers.org).
All offers of appointment are subject to CRB checks. The London Deanery will inform your first employing Trust of
your offer of appointment, however on receiving your offer you should make contact with the Medical Staffing
Department at your Trust to arrange for a CRB check.


The London Deanery would like to wish you good luck with your application and your future career.


Updated 8th May 2006




Professor Elisabeth Paice MA FRCP
Dean Director of Postgraduate Medical & Dental Education
                                         THE LONDON DEANERY
                                         General Statement of Policy
 General Statement of Policy regarding fitness to practise proceedings by a licensing/regulatory
                            body and relating to criminal records.

Registration with a professional body, such as the General Medical Council or General Dental Council, imposes
a duty on health care professionals to provide a good standard of medical care for, and behave appropriately
towards, patients. NHS employers also have a duty to ensure that patients receive a good standard of medical
care and to take all practicable steps to ensure the safety of patients and staff.

In order to assess job related risks, the London Deanery needs to establish if applicants who may be offered a
placement on a training programme have a criminal record in the UK or in another country that they can lawfully
be required to disclose.

Applicants for training posts are exempted from the Rehabilitation of Offenders Act 1974, and can therefore be
asked to disclose “spent” convictions that they would otherwise not have to declare.

Applicants for training posts will also be asked if they are “bound over”, have received a police caution, warning
or reprimand and whether they have been charged with a criminal offence that is not yet disposed of.

Prior to making an appointment, the London Deanery also needs to establish if applicants for training posts
have ever been disqualified from the practice of a profession or required to practise it subject to specified
limitations following fitness to practise proceedings by a regulatory body in the UK or in another country, and
whether they are 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.

Where such a position involves regular care, training, supervision or sole charge of persons aged under 18 or
vulnerable adults (as defined by The Police Act 1997 (Enhanced Criminal Record Certificates)(Protection of
Vulnerable Adults) Regulations 2000), applicants will also be asked whether they are currently the subject of
any police investigation in the UK or any other country of which they are aware.

Where the position is a “regulated position” under the terms of the Protection of Children Act 1999 (as amended
by the Criminal Justice and Court Services Act 2000), checks will be carried out in accordance with the
Protection of Children Act 1999. Anyone whose name is on the list is legally barred from working with children.
It is an offence for such a person to knowingly apply for, offer to do, accept or to do such work. If you are
appointed to a training post, you will be subject to a Criminal Records Bureau (CRB) check.

Applicants are encouraged to declare criminal conviction information and any other matters that are, or that
might be, relevant to the position for which they are applying at an early stage in the appointment process.

All applicants are also expect to inform the London Deanery if, before taking up any position offered to them,
they are charged with a criminal offence in the UK or another country.

The London Deanery is an equal opportunities recruiter, and all applications will be decided fairly and on merit.
Information declared will be used to consider the applicant‟s suitability for the position. Information supplied will
be treated in confidence and will not be used as the sole criterion to decide an applicant‟s fitness for the
position.

Unless an appointment is prohibited by law, a criminal conviction will not automatically debar the applicant from
appointment. Applicants will be given an opportunity to discuss any information supplied before a final decision
is taken regarding their appointment.

 Professor Elisabeth Paice MA FRCP
 Dean Director of Postgraduate Medical & Dental Education
However, an applicant may not be selected if the selection panel considers that the information declared
renders that person unsuitable for the position for which they have applied. In reaching such a decision the
London Deanery will consider the nature of the record/action, its relevance to the position applied for, and any
other information the applicant wishes to provide.

The information declared will be treated in compliance with the Data Protection Act 1998.

NOTE: Failure by an applicant to provide accurate and truthful information is considered to be a serious
matter.

Where it is found that a person has intentionally or recklessly provided inaccurate information or
withheld information relevant to his/her position, this may disqualify them from an appointment, or if
appointed, dismissal and referral to the appropriate professional regulatory body.

If you would like to discuss what effect any criminal record or fitness to practise proceedings might have on your
application, you may telephone Victor Orton or Jane Appleyard, telephone 0207 866 3105, in the Medical
Workforce department, in confidence or email fitnesstopractise@londondeanery.ac.uk

Any information you provide regarding criminal investigations, convictions or fitness to practise proceedings will
be kept confidential. If the Deanery considers that the information provided may have a bearing on your
appointment and that the information needs to be considered by the selection panel, we will discuss this with
you in advance. If we do not raise this information with you, this is because we do not believe that it should be
taken into account. In that event, you still remain free, should you wish, to discuss the matter with the
interviewing panel.

Prior to making a final decision concerning your application, we shall discuss with you any information declared
by you that we believe has a bearing on your suitability for the position.

The London Deanery aims to promote equality of opportunity and is committed to treating all applicants for
positions fairly and on merit regardless of race, gender, marital status, religion, disability, sexual orientation or
age. We undertake not to discriminate unfairly against applicants on the basis of criminal conviction or other
information declared.

The Data Protection Act 1998 requires us to provide you with certain information and to obtain your consent
before processing sensitive data about you. Processing includes: obtaining, recording, holding, disclosing,
destruction and retaining information. Sensitive personal data includes any of the following information: criminal
offences, criminal convictions, criminal proceedings, disposal or sentence.

The information that you provide on the Declaration Form in the application form will be processed in
accordance with the Data Protection Act 1998, and will only be used for the purpose of determining your
application for this position. Once a decision has been made concerning your appointment, we will not retain
this Declaration Form longer than is necessary (i.e. until you leave your post/programme or the recruitment
episode is closed).

The Declaration Form will be kept in securely and in confidence, and access to it will be restricted to designated
persons within the Medical Workforce Department of the London Deanery and other persons who need to see it
as part of the selection process and who are authorised to do so. The information may be passed to your
employing trusts.




 Professor Elisabeth Paice MA FRCP
 Dean Director of Postgraduate Medical & Dental Education
 To applicants: you should complete your application form after carefully reading this person
 specification which is based on the GMC’s “Good Medical Practice”




                                                     THE LONDON DEANERY

         In association with the East of England and Kent, Surrey & Sussex (KSS) Deaneries

                                  DENTAL FOUNDATION TRAINING YEAR 2 POSTS

                                                    PERSON SPECIFICATION


                            ESSENTIAL                            WHEN                DESIRABLE                               WHEN
                                                                 EVALUATED                                                   EVALUATED
QUALIFICIATIONS              Eligible for registration          AF                   BSc (or other intercalated            AF
                              with the GDC                                             degree), other degrees /
                                                                                       qualifications
                             BDS (or equivalent)                AF

CLINICAL EXPERIENCE
                             Satisfactory completion            AF
                              of Vocational Training,
                              or Performers List
                              Number by time of
                              appointment.
                             Not more than 30                   AF / I/V
                              months post
                              graduation experience
                              working as a dentist, by
                              time of appointment
CLINICAL SKILLS
                             Basic Life Support                 AF
                              skills
                             Demonstrates an                    AF, I/V
                              awareness of own
                              limitations.
                             Understanding of
                                                                 I/V
                              clinical risk
                              management
                             Competent to work                  I/V, Ref
                              without direct
                              supervision where
                              appropriate
                             Good manual dexterity
                              and hand / eye co-                 Ref
                              ordination
KNOWLEDGE                    Appropriate level of               Ref, I/V             Demonstrates use of
                              clinical knowledge                                       evidence informed                     I/V
                                                                                       practice
                             Shows knowledge of                 I/V
                              evidence informed
                              practice


ORGANISATION AND             Ability to prioritise              I/V, Ref             Understanding of audit                I/V
PLANNING                      clinical need
                                                                                      Evidence of participation             I/V


  AF = Application Form
  I/V = Interview
  Ref = Reference

  Any attributes which are evaluated on the basis of the application form alone may be further explored at the interview stage
To applicants: you should complete your application form after carefully reading this person
specification which is based on the GMC’s “Good Medical Practice”




                            ESSENTIAL                            WHEN                DESIRABLE                               WHEN
                                                                 EVALUATED                                                   EVALUATED
                             Ability to organise                I/V, Ref                in audit
                              oneself and own work

                             Experience and ability             I/V, Ref
                              to work in multi-
                              professional teams

                             Understanding of NHS,              AF, I/V
                              clinical governance &
                              resource constraints;
                              management
ACADEMIC /                                                       I/V                  Research experience,                  I/V
RESEARCH                                                                               presentations,
                                                                                       publications, prizes and
                                                                                       honours

                                                                                      Understanding of the                  I/V
                                                                                       principles of research
CAREER                      Commitment to Dental                 AF, I/V, Ref
PROGRESSION                 Foundation Training
START DATE                                                                            [available to start on 3rd            AF, I/V
                                                                                       February 2010]
PERSONAL SKILLS               COMMUNICATION &                   AF, I/V, Ref
                               LANGUAGE SKILLS
                               (the ability to
                               communicate with
                               clarity and intelligibility
                               in written and spoken
                               English; ability to build
                               rapport, listen,
                               persuade, negotiate)
                             DECISIVENESS/                      I/V, Ref
                              ACCOUNTABILITY
                              (ability to take
                              responsibility, show
                              leadership, make
                              decisions, exert
                              appropriate authority)




  AF = Application Form
  I/V = Interview
  Ref = Reference

  Any attributes which are evaluated on the basis of the application form alone may be further explored at the interview stage
PERSONAL SKILLS              INTERPERSONAL                      AF, I/V, Ref
(CONT )                       SKILLS (see patients
                              as people, empathise,
                              work co-operatively
                              with others, open and
                              non-defensive, sense
                              of humour)
                             USES A NON-                        Ref
                              JUDGMENTAL
                              APPROACH TO
                              PATIENTS AND
                              COLLEAGUES
                              regardless of their
                              sexuality, ethnicity,
                              disability, religious
                              beliefs or financial
                              status
                             FLEXIBILITY (able to               I/V, Ref
                              change and adapt,
                              respond to rapidly
                              changing
                              circumstances)
                             RESILIENCE (able to                I/V, Ref
                              operate under
                              pressure, cope with
                              setbacks, self-aware)
                             THOROUGHNESS (is                   I/V, Ref
                              well prepared, shows
                              self-
                              discipline/commitment,
                              is punctual and meets
                              deadlines)
                             SHOWS INITIATIVE/                  I/V, Ref
                              DRIVE/ENTHUSIASM
                              (self-starter, motivated,
                              shows curiosity,
                              initiative)
                             PROBITY (displays                  I/V, Ref
                              honesty, integrity,
                              aware of ethical
                              dilemmas, respects
                              confidentiality)
PHYSICAL                     Meets professional                 pre-
REQUIREMENTS                  health requirements                employment
                                                                 health
                                                                 screening




  AF = Application Form
  I/V = Interview
  Ref = Reference

  Any attributes which are evaluated on the basis of the application form alone may be further explored at the interview stage
                     APPLICATION FOR EMPLOYMENT: PART ONE
    Please fill in this application form, which is split into two parts. Access to Part   For Office Use Only
    One information will be withheld from the shortlisting or interviewing panel.         Reference Number:
    Please complete the form and check it carefully before returning it to:
    2009E2DentalFoundation2@londondeanery.ac.uk


   The information you enter on this Part One form will not be used in assessing and scoring your application.
   If you are successful in being offered employment, the details entered in this part of the application form
   will be passed to the HR department of your employer.

   Please note incomplete application forms will not be considered.
   I confirm that I have read the above statement and understand the implications if I do not complete this
   application form correctly
                                  THE LONDON DEANERY APPLICATION FORM FOR

                                    DENTAL FOUNDATION TRAINING YEAR 2 POSTS
                                             TRAINING PROGRAMME

                                                                  PART ONE
                                                                  REF: 061/40

Section A – Personal Details
Personal Details
Surname/Family Name

First Names
Name in which you are
registered with the GMC (or                                           Date of Birth dd/mm/yyyy
GDC) if different to above
                                                                      UK National Insurance
Title                                    ---Please Select---
                                                                      Number
Contact Address
             Address Line 1

                     Address Line 2

                               Town

Postcode                                                              Country

Home Telephone                                                        Mobile Telephone
                                                                      May we contact you at
Work Telephone                                                                                        Yes       No
                                                                      work?
                                                                      1
Email address – please note MOST Deanery communications                 email address:
will be via email so you must provide an active email address which
you check regularly and you must inform the Deanery of any change




                 1
                  See advice in the Applicant Guide concerning the best email addresses to use in your
                 application form


                                                                        9
                APPLICATION FOR EMPLOYMENT: PART ONE
  Please fill in this application form, which is split into two parts. Access to Part   For Office Use Only
  One information will be withheld from the shortlisting or interviewing panel.         Reference Number:
  Please complete the form and check it carefully before returning it to:
  2009E2DentalFoundation2@londondeanery.ac.uk




Section B – Equal Opportunities Monitoring Information

As public sector employers, healthcare organisations are required to collect details about an applicant‟s age, gender,
ethnicity, religious beliefs and disabilities. This is to ensure they meet their statutory requirements and to encourage
the recruitment of a diverse workforce that represents the communities they serve. This information is collected to
fulfil that obligation.


The NHS is committed to equal opportunities. No applicants will be discriminated against on the grounds of colour,
race, ethnic origin, nationality, age, disability, gender, sexual orientation, marital status, or religion.


Date of Birth
(dd/mm/yyyy)
Gender
(Please select from the         ---Please Select---
drop down list provided)

Race Relations (Amendment) Act 2000
 I would describe my ethnic origin as: (please select from the drop down list provided)

         Ethnic origin:                                   ---Please Select---
         If you selected Other please specify:             Please type here


Employment Equality Regulations 2003
 Please select the option which best describes your sexuality (please select from the drop down list provided)

         Sexuality:         ---Please Select---

 Please indicate your religious belief (please select from the drop down list provided)

         Religion:           ---Please Select---



                                                                    Yes           I do not wish to disclose this information
Do you consider yourself to have a disability?
                                                                    No

Please state the type of impairment which applies to you. People may experience more than one type of impairment,
in which case you may indicate more than one. If none of the categories apply, please mark „other‟.


        Physical Impairment               Learning Disability/Difficulty            Mental Health Condition
        Sensory Impairment                Long-standing illness                     Other




                                                                     10
                 APPLICATION FOR EMPLOYMENT: PART ONE
  Please fill in this application form, which is split into two parts. Access to Part   For Office Use Only
  One information will be withheld from the shortlisting or interviewing panel.         Reference Number:
  Please complete the form and check it carefully before returning it to:
  2009E2DentalFoundation2@londondeanery.ac.uk


If you have a disability do you require any specific arrangements to enable you to attend for
                                                                                                                  Yes     No
interview?
If YES (I have a disability which I consider relevant to my application), please describe any adaptation or adjustment you
consider an employer should make to accommodate you if you are shortlisted for interview / appointed on a separate piece of
paper and place in a sealed envelope addressed to Jane Appleyard, Medical Workforce, London Deanery, Stewart
House, 32 Russell Square, London WC1B 5DN. Please mark the envelope “CONFIDENTIAL”.

Please also let us know if you need any special arrangements to enable you to attend for interview. Alternatively, you may al so
send an email to 2009confidentialenquiries@londondeanery.ac.uk.
If you have a disability, provided you meet the minimum criteria as specified in the Person
Specification, do you wish to be considered under the Guaranteed Interview Scheme?

If you tick this box you must email 2009ConfidentialEnquiries@londondeanery.ac.uk to ensure your                  Yes     No
eligible for the guaranteed interview scheme. Failure to do so may result in you not being granted a
guaranteed interview. Emails to this address are managed in strict confidence and will not be
shared with the interview panel. Please see the Disability Discrimination Act for more details.

 Do you wish to apply for a deferred start date because you are registered for a higher degree (e.g. PhD, MD)?

           Yes                         No
 Date available to start post (If this is later than the intended post start
 date please give reasons):




Do you wish to be considered for less than full-time training?
If you select „Yes‟ as you wish to be considered for less than full time training, this information will not be made known
to the selection panel but you will need to formally apply for less than full-time training via the deanery Flexible Training
Team. Further guidance and details on how to apply can be found on the deanery website.


    Yes                          No




 Section C – Eligibility to Apply
 Professional Registration
 Type of registration                       GDC Number                  Renewal date            Name in which you are registered

 ---Please Select---

 If not registered with the GDC at time of application, will you be eligible for registration by the time of
 appointment? Please give details below.




                                                                     11
               APPLICATION FOR EMPLOYMENT: PART ONE
 Please fill in this application form, which is split into two parts. Access to Part   For Office Use Only
 One information will be withheld from the shortlisting or interviewing panel.         Reference Number:
 Please complete the form and check it carefully before returning it to:
 2009E2DentalFoundation2@londondeanery.ac.uk




Section D – Language Skills
You are required to demonstrate skills in written and spoken English that are adequate to enable effective
communication about medical and/or health topics with patients, colleagues and the public.
Evidence of English language proficiency (please select)
Country of Primary Medical Qualification (see list within Appendix A)
Was your undergraduate training taught in English language                                             Yes     No
Have your language skills been tested through the IELTS (International English Language                Yes     No
Testing System) to the minimum overall score required as per the Person Specification?
                                                                                                       Score
Date IELTS taken (dd/mm/yyyy)
Other – please provide details below – provide evidence of your English language proficiency (max 50 words)




Where did you see this post advertised?
London Deanery website                         BMJ                           NHS Jobs




                                                                    12
                     APPLICATION FOR EMPLOYMENT: PART ONE
     Please fill in this application form, which is split into two parts. Access to Part   For Office Use Only
     One information will be withheld from the shortlisting or interviewing panel.         Reference Number:
     Please complete the form and check it carefully before returning it to:
     2009E2DentalFoundation2@londondeanery.ac.uk


    Section E – Immigration Status
Right to Work in the United Kingdom
Your eligibility to apply for this position will be determined by your immigration status on the closing
date for applications for this post. Some applicants may be considered before others on the basis of
immigration status, in accordance with the Immigration, Asylum and Nationality Act 2006.

    1      Are you a United Kingdom (UK), European Community (EC) or European Economic Area                       Yes   No
           (EEA) national?2 (please select as appropriate)
    2   If not, do you have evidence of entitlement to enter and work permanently in the United      Yes No
        Kingdom without restriction i.e. Indefinite Leave to remain – free from immigration control?
        (please select as appropriate)
If you have selected no to both of the above please mark with a cross the boxes below in the Personal Status
section which define your immigration status and complete start and expiry date of your permit, unless you
also tick yes to the question below, in which case you need to go to the Partner/Civil Partner/Spouse Status
section.
   3    Are you on a dependents visa*                                                                Yes No
        *If you have answered YES please complete the Partner/Civil Partner/Spouse status
        section

Personal Status
Nationality (Choose country pertaining to your nationality - see country list –
Appendix A)
Select      Status                                                                                   Start Date   Expiry Date
            Highly Skilled Migrant Programme (dates of endorsement stamp in passport)

            Points based system – with endorsement “no employment as a doctor in training”

            Points based system – no endorsement regarding “employment as a doctor in
            training”
            Permit Free Training / Postgraduate doctor or dentist

            Refugee in the UK

            Work Permit / Tier 2

            Tier 4

            UK ancestry

            Student visa holder

            Other immigration categories i.e. Overseas government employees, Innovators etc.

If Other than above – Please specify the immigration category (Max 50 words – 455 Characters)




2
    For the purposes of this form Switzerland has been included within the EEA national category


                                                                        13
                   APPLICATION FOR EMPLOYMENT: PART ONE
     Please fill in this application form, which is split into two parts. Access to Part   For Office Use Only
     One information will be withheld from the shortlisting or interviewing panel.         Reference Number:
     Please complete the form and check it carefully before returning it to:
     2009E2DentalFoundation2@londondeanery.ac.uk



Partner / civil partner / spouse status
Please complete this section if you have answered YES to question 3 above.
Nationality (Choose country pertaining to your nationality - see country list –
Appendix A)

Select       Status                                                                                  Start Date   Expiry Date
                                                            3
             Partner / civil partner or spouse of UK / EEA citizen
                                                                           4
             Non EEA national partner / civil partner or spouse of EEA citizen exercising a treaty
             right
             Partner / civil partner or spouse of HSMP holder

             Partner / civil partner or spouse under the Points based system – with endorsement
             “no employment as a doctor in training”
             Partner / civil partner or spouse under the Points based system – no endorsement
             regarding “employment as a doctor in training”
             Partner / civil partner or spouse of student visa holder – student visa holder must
             have 12 months or more leave to remain
             Partner / civil partner or spouse of other immigration categories i.e. refugees, work
             permit holders, Overseas government employees, Innovators etc.
If Other than above – Please specify the immigration category (Max 50 words – 455 Characters)




    If you are shortlisted, you will be required to produce the original documents (passports, page
                 with the stamp and letter from the Home Office) on the interview day.




3
    For the purposes of this form Switzerland has been included within the EEA national category


                                                                        14
                APPLICATION FOR EMPLOYMENT: PART ONE
  Please fill in this application form, which is split into two parts. Access to Part   For Office Use Only
  One information will be withheld from the shortlisting or interviewing panel.         Reference Number:
  Please complete the form and check it carefully before returning it to:
  2009E2DentalFoundation2@londondeanery.ac.uk




Section F – Fitness to Practise and Criminal Investigations
The London Deanery aims to promote equality of opportunity and is committed to treating all applicants for positions
fairly and on merit regardless of race, gender, marital status, religion, disability, sexual orientation or age. We
undertake not to discriminate unfairly against applicants on the basis of criminal conviction or other information
declared.
Prior to making a final decision concerning your application, we shall discuss with you any information declared by you
that we believe has a bearing on your suitability for the position. If we do not raise this information with you, this is
because we do not believe that it should be taken into account. In that event, you still remain free, should you wish to
discuss the matter with the interviewing panel. As part of assessing your application, we will only take into account
relevant criminal record and other information declared.
The Data Protection Act 1998 requires us to provide you with certain information and to obtain your consent before
processing sensitive data about you. Processing includes: obtaining, recording, holding, disclosing, destruction and
retaining information. Sensitive personal data includes any of the following information: criminal offences, criminal
convictions, criminal proceedings, disposal or sentence.
The information that you provide in this Declaration Form will be processed in accordance with the Data Protection Act
1998. It will be used for the purpose of determining your application for this position. It will also be used for purposes of
enquiries in relation to the prevention and detection of fraud. Once a decision has been made concerning your
appointment, we will not retain this Declaration Form longer than is necessary (i.e. until you leave your post /
programme or the recruitment episode is closed).
This Declaration Form and any information provided relating to a positive declaration will be kept securely and in
confidence, and access to it will be restricted to designated persons within the Medical Workforce Department of the
London Deanery and other persons who need to see it as part of the selection process and who are authorized to do
so. The information may be passed to your employing trusts.
Before you can be considered for appointment in a position of trust as a Vocational Dental Practitioner on a
London Deanery programme, we need to be satisfied about your character and suitability.
It is vitally important that you read, understand and answer the questions asked in this section – please read
the accompanying notes carefully before completing this declaration form.
Please answer all of the following questions. If you answer “YES” to any of the questions, please provide full details on
a separate sheet (quoting Ref: VDP001-2009) and place in a sealed envelope addressed to Jane Appleyard, Medical
Workforce, London Deanery, Stewart House, 32 Russell Square, London WC1B 5DN. Alternatively, you can email the
details to fitnesstopractise@londondeanery.ac.uk .Please mark the envelope “CONFIDENTIAL”.
The position for which you have applied is exempted from the Rehabilitation of Offenders Act 1974. This
means that you must declare all criminal convictions, including those that would otherwise be considered
“spent”.
Answering “YES” to any of the questions below will not necessarily bar you from appointment. This will
depend on the nature of the position for which you are applying and the particular circumstances.
If you would like to discuss what effect any previous convictions, police investigations or fitness to practice 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: Jane Appleyard at the Deanery on 020 7 866 3105 in confidence.




                                                                     15
                  APPLICATION FOR EMPLOYMENT: PART ONE
    Please fill in this application form, which is split into two parts. Access to Part   For Office Use Only
    One information will be withheld from the shortlisting or interviewing panel.         Reference Number:
    Please complete the form and check it carefully before returning it to:
    2009E2DentalFoundation2@londondeanery.ac.uk


1       Are you currently bound over or have you ever been convicted of any offence by a Court
        or Court-Martial in the United Kingdom or in any other country? NB You do not need to                   YES   NO
        tell us about parking offences.
2       Have you ever received a police caution, reprimand or final warning?                                    YES   NO
3       Have you been charged with any offence in the United Kingdom or in any other country
        that has not yet been disposed of? Please note: you must inform us immediately if
        you are charged with any offence in the United Kingdom or in any other country                          YES   NO
        after you complete this form and before taking up any position offered to you. You
        do not need to tell us if you are charged with a parking offence.
4       Are you aware of any current police investigation in the United Kingdom or in any other                 YES   NO
        country following allegations made against you?

5       Are you aware of any current NHS Counter Fraud and Security Management Service                          YES   NO
        investigation following allegations made against you?

6       Have you ever been investigated by the Police, CFSMS or any other Investigatory Body
        resulting in a caution, conviction or dismissal from your employment? (Investigatory
        bodies include Local Authorities, Customs & Excise, Immigration, Passport Agency,                       YES   NO
        Inland Revenue, Department of Trade & Industry, Banks and Building Societies, General
        Life Insurance Companies – this list is not exhaustive, and you must declare any
        investigation conducted by an Investigatory Body).
7       Have you ever been dismissed by reason of misconduct from any employment, office or                     YES   NO
        other position previously held by you?

8       Have you ever been disqualified from the practice of a profession or required to practice
        subject to specified limitations / conditions / warnings following fitness to practice                  YES   NO
        proceedings by a regulatory or licensing body in the United Kingdom or in any other
        country?
9       Are you currently the subject of any investigation or fitness to practice proceeding by any             YES   NO
        employer, any licensing or regulatory body in the United Kingdom or any other country?

10      Are you subject to any other prohibition, limitation, or restriction that means we are                  YES   NO
        unable to consider you for the position for which you are applying?

If you have answered “YES” to any of the questions, please provide full details on a separate sheet and place in a
sealed envelope addressed to Jane Appleyard, Medical Workforce, London Deanery, Stewart House, 32 Russell
Square, London, WC1B 5DN. Alternatively, you can email the details to fitnesstopractise@londondeanery.ac.uk .
Please indicate clearly the number(s) of the question (s) that you are answering. Please mark the envelope
“CONFIDENTIAL”
You are reminded that if you are appointed to a training post or programme, you will have a continuing responsibility to
inform your employer(s) and the Postgraduate Dean of any new criminal convictions, police investigations or fitness to
practice proceedings that arise in the future.
Note: if you wish to withdraw your consent at any time after completing this Declaration Form, please contact Jane
Appleyard at the Deanery (see above).




                                                                       16
               APPLICATION FOR EMPLOYMENT: PART ONE
 Please fill in this application form, which is split into two parts. Access to Part   For Office Use Only
 One information will be withheld from the shortlisting or interviewing panel.         Reference Number:
 Please complete the form and check it carefully before returning it to:
 2009E2DentalFoundation2@londondeanery.ac.uk



Section G - Referees

Reference reports are not used for scoring purposes during shortlisting or interview but will be reviewed during the
selection process and again prior to confirmation of appointment for successful applicants. The reference process is
designed to check the accuracy of your previous employment and training history and to provide assurance of your
qualifications, integrity and track record.

You must provide contact details, including e-mail addresses, of three referees who have supervised your clinical
training during the last three years of your employment or undergraduate training. One referee must be your
current or most recent consultant or educational supervisor familiar with your clinical development.

Your clinical referees should be contacted by you in advance to confirm that they are willing to provide a reference and
are available and able to do so in the time period required for selection and appointment, should you be successful.

Please ensure these details are correct as you will be unable to begin in post until references are supplied and
checked.




                                                                    17
                APPLICATION FOR EMPLOYMENT: PART ONE
  Please fill in this application form, which is split into two parts. Access to Part    For Office Use Only
  One information will be withheld from the shortlisting or interviewing panel.          Reference Number:
  Please complete the form and check it carefully before returning it to:
  2009E2DentalFoundation2@londondeanery.ac.uk



Reference 1                                              Post Details (Post held by applicant)
(Present or       Specialty:                                                 Start Date:
most recent
                  Level:                                                     End Date:
Consultant/
Educational                                               Consultant/Educational supervisor
Supervisor)
                  Name:
                  Job Title:
                  Address:




                  Town:
                  County:
                  Post code:
                  Country:

                  Telephone Number:
                  Fax Number:
                  Email address:


Reference 2                                            Post Details (Post held by applicant)
                 Specialty:                                                Start Date:
                 Level:                                                    End Date:
                                                        Consultant/Educational supervisor
                 Name:
                 Job Title:
                 Address:




                 Town:
                 County:
                 Post code:
                 Country:

                 Telephone Number:
                 Fax Number:
                 Email address:




                                                                     18
                APPLICATION FOR EMPLOYMENT: PART ONE
  Please fill in this application form, which is split into two parts. Access to Part    For Office Use Only
  One information will be withheld from the shortlisting or interviewing panel.          Reference Number:
  Please complete the form and check it carefully before returning it to:
  2009E2DentalFoundation2@londondeanery.ac.uk




Reference 3                                            Post Details (Post held by applicant)
                 Specialty:                                                Start Date:
                 Level:                                                    End Date:
                                                        Consultant/Educational supervisor
                 Name:
                 Job Title:
                 Address:




                 Town:
                 County:
                 Post code:
                 Country:

                 Telephone Number:
                 Fax Number:
                 Email address:




 Entry Criteria checklist

 You should select the following checklist to indicate that you have completed this application form in
 conjunction with the entry criteria set out in the relevant Specialty/entry level Person Specification for the
 post applied for.


 Entry Criteria

 I meet the entry qualifications

 I have the right to work in the UK

 I have no fitness to practise restrictions, or any other prohibition, limitation or restriction which would
 prevent me from applying for this post

 I am proficient in English Language Skills at the required level




                                                                     19
               APPLICATION FOR EMPLOYMENT: PART ONE
Please fill in this application form, which is split into two parts. Access to Part     For Office Use Only
One information will be withheld from the shortlisting or interviewing panel.           Reference Number:
Please complete the form and check it carefully before returning it to:
2009E2DentalFoundation2@londondeanery.ac.uk



APPENDIX A
Country of Origin
Afghanistan                        El Salvador                         Malaysia                      Singapore
Albania                            Equatorial Guinea                   Maldives                      Slovakia (Slovak Republic)
Algeria                            Eritrea                             Mali                          Slovenia
American Samoa                     Estonia                             Malta                         Solomon Islands
Andorra                            Ethiopia                            Marshall Islands              Somalia
Angola                             Falkland Islands (Malvinas)         Martinique                    South Africa
Anguila                            Faroe Islands                       Mauritania                    South Georgia and South
Antarctica                         Fiji                                Mauritius                     Sandwich Islands
Antigua and Barbuda                Finland                             Mayotte                       South Korea
Argentina                          France                              Mexico                        Spain
Armenia                            French Guiana                       Micronesia (Federated         Sri Lanka
Aruba                              French Southern Territories         States of)                    St Helena
Australia                          Gabon                               Moldova                       St Pierre and Miquelon
Austria                            Gambia                              Monaco                        Sudan
Azerbaijan                         Georgia                             Mongolia                      Suriname
Bahamas                            Germany                             Montserrat                    Svalbard and Jan Mayen
Bahran                             Ghana                               Morocco                       Islands
Bangladesh                         Gibraltar                           Mozambique                    Swazilan
Barbados                           Greece                              Myanmar                       Sweden
Belarus                            Greenland                           Namibia                       Switzerland
Belgium                            Grenada                             Nauru                         Syrian Arab Republic
Belize                             Guadeloupe                          Nepal                         Taiwan
Berin                              Guam                                Netherland Antilles           Tajikistan
Bermuda                            Guatemala                           Netherlands                   Tanzania
Bhutan                             Guinea                              New Caledonia                 Thailand
Bolivia                            Guinea Bissau                       New Zealand                   Togo
Bosnia & Herzegovina               Guyana                              Nicaragua                     Tokelau
Botswana                           Haiti                               Niger                         Tonga
Bouvet Island                      Heard and McDonald                  Nigeria                       Trinidad and Tobago
Brazil                             Islands                             Niue                          Tunisia
British Indian Ocean               Honduras                            Norfolk Islands               Turkey
Territory                          Hong Kong                           North Korea                   Turkmenistan
Brunei Darussalam                  Hungary                             Northern Mariana Islands      Turks and Caicos Islands
Bulgaria                           Iceland                             Norway                        Tuvalu
Burkina Faso                       India                               Oman                          Uganda
Burundi                            Indonesia                           Pakistan                      Ukraine
Cambodia                           Iran (Islamic Republic)             Palau                         United Arab Emirates
Cameroon                           Iraq                                Palestinian Territory         United Kingdom
Canada                             Ireland                             (Occupied)                    United States of America
Cape Verde                         Israel                              Panama                        United States Minor
Cayman Islands                     Italy                               Papua New Guinea              Outlying Islands
Central African Republic           Jamaica                             Paraguay                      Uruguay
Chad                               Japan                               Peru                          Uzbekistan
Chile                              Jordan                              Philippines                   Vanuatu
China                              Kazakhstan                          Pitcairn                      Vatican City State (Holy
Christmas Island                   Kenya                               Poland                        See)
Cocos (Keeling) Islands            Kiribati                            Portugal                      Venezuela
Colombia                           Kosovo                              Puerto Rico                   Vietnam
Comoros                            Kuwait                              Qatar                         Virgin Islands (British)
Congo (Republic of)                Kyrgyzstan                          Reunion                       Virgin Islands (U.S.)
Cook Islands                       Lao Peoples Democratic              Romania                       Wallis and Futuna Islands
Costa Rica                         Republic                            Russian Federation            Western Sahara
Côte d'Ivoire                      Latvia                              Rwanda                        Yemen
Croatia                            Lebanon                             Saint Kitts and Nevis         Yugoslavia
Cuba                               Lesotho                             Saint Lucia                   Zambia
Cyprus                             Liberia                             Saint Vincent and the         Zimbabwe
Czech Republic                     Libyan Arab Jamahiriya              Grenadines
Denmark                            Liechtenstein                       Samoa
Djibouti                           Lithuania                           San Marino
Dominica                           Luxembourg                          Sao Tome and Principe
Dominican Republic                 Macau                               Saudi Arabia
East Timor                         Macedonia                           Senegal
Ecuador                            Madagascar                          Seychelles
Egypt                              Malaw                               Sierra Leone




                                                                 20
               APPLICATION FOR EMPLOYMENT: PART TWO
 Please fill in this application form, which is split into two parts. Access to Part One information   For Office Use Only
 will be withheld from the shortlisting or interviewing panel. Please complete the form and            Reference Number:
 check it carefully before returning it to: 2009E2DentalFoundation2@londondeanery.ac.uk




Please complete this application carefully. CVs and additional pages will not be
accepted.

                                 DENTAL FOUNDATION TRAINING YEAR 2 POSTS
                                               PART TWO
                                               Ref: 061/40


Section H – Professional Qualifications
Degree/Diploma / Postgraduate                          Awarding Body                                   Date of Qualification
qualifications (include BSc, BDS, etc) –
state class of degree awarded




Please give details of any research degree
(e.g. MD, PhD) currently being undertaken



       Shortlisted candidates will be required to bring original certificates (if applicable) to the interview




                                                                  21
               APPLICATION FOR EMPLOYMENT: PART TWO
 Please fill in this application form, which is split into two parts. Access to Part One information   For Office Use Only
 will be withheld from the shortlisting or interviewing panel. Please complete the form and            Reference Number:
 check it carefully before returning it to: 2009E2DentalFoundation2@londondeanery.ac.uk




Section I – Employment (if applicable)
Your Vocational Training (VT) Post
Name of Deanery:                                                     Name of VT Scheme:

Name of Scheme Advisor                                               Address and postcode of Scheme Advisor:



Name of Vocational Trainer(s)                                        Address of Vocational Trainer:



Telephone number:

Performers List Number (If Applicable)
Number:                         Awarding PCT:



Section J - Current and Previous Employment as a Dentist (if applicable)
(Excluding Vocational Training)
Current Employer:
Address:
Current position e.g Trust Dentist                          From                         To                    Months in post




Previous experience
Please list in chronological order (most recent first)
Employers Name and Address                         Post (e.g. Trust Dentist)      From                 To           Months in
                                                                                                                    post




                                                                   22
              APPLICATION FOR EMPLOYMENT: PART TWO
Please fill in this application form, which is split into two parts. Access to Part One information   For Office Use Only
will be withheld from the shortlisting or interviewing panel. Please complete the form and            Reference Number:
check it carefully before returning it to: 2009E2DentalFoundation2@londondeanery.ac.uk




                                                                 23
               APPLICATION FOR EMPLOYMENT: PART TWO
 Please fill in this application form, which is split into two parts. Access to Part One information   For Office Use Only
 will be withheld from the shortlisting or interviewing panel. Please complete the form and            Reference Number:
 check it carefully before returning it to: 2009E2DentalFoundation2@londondeanery.ac.uk




Section K – Clinical Knowledge and Experience
    a) Describe how the Vocational Training experience has improved your care of patients. (150 Words max)




    b) Reflecting on your experience in Vocational Training, please give two examples that highlighted areas of
       clinical dentistry in which you felt you were less competent. What steps have you taken to address this? (150
       Words)




Basic Life Support                                 Date:                       Place:
Please give date and location of last
training




                                                                  24
               APPLICATION FOR EMPLOYMENT: PART TWO
 Please fill in this application form, which is split into two parts. Access to Part One information   For Office Use Only
 will be withheld from the shortlisting or interviewing panel. Please complete the form and            Reference Number:
 check it carefully before returning it to: 2009E2DentalFoundation2@londondeanery.ac.uk




Section L – Aims and Career Objectives
List up to 5 reasons why you want to do a Foundation Year 2 post. (75 words)




Reflecting on your experience in Vocational Training, please describe any management duties or responsibilities you
have undertaken. How has the experience been of benefit? (150 Words)




Section M – Notes
1     Children and Vulnerable Adults
      Where the appointment involves substantial access to children and/or vulnerable adults, the appointment is
      subject to a police check. The Criminal Records Bureau will be asked to verify that you have no convictions
      and cautions or pending prosecutions, convictions, cautions and bind-over orders. This will include local police
      force records in addition to checks with the Police National Computer and the government department lists held
      by the Department of Health and Department for Education & Employment, where appropriate.
2     Declaration
      If you are related to a member or Senior Officer/Manager of the Trusts involved in the training programme, you
      must disclose such a relationship. You are also required to declare any involvement, either directly or
      indirectly, with any firm, company or organisation which has a contract with Trusts involved in the training
      programme. Failure to declare any information on these matters may result in your application being rejected
      or, if it is discovered after appointment that such information has been withheld, then this may lead to dismissal.
      Please note canvassing of a Senior Officer/Manager shall disqualify an applicant. Please state any
      disclosure/declaration related to the above on a separate sheet.




                                                                  25
               APPLICATION FOR EMPLOYMENT: PART TWO
 Please fill in this application form, which is split into two parts. Access to Part One information   For Office Use Only
 will be withheld from the shortlisting or interviewing panel. Please complete the form and            Reference Number:
 check it carefully before returning it to: 2009E2DentalFoundation2@londondeanery.ac.uk




Section N – Equal Opportunities
The London Deanery aims to promote equality of opportunity and is committed to treating all applicants for positions
fairly and on merit regardless of race, national origin, gender, gender reassignment, marital status, civil partner
status, religion, disability, sexual orientation or age.

Section O – Accepting an Appointment
You must take up any post, including a locum post, you have formally accepted unless the employer has adequate
                                                                                                      rd
time to make other arrangements. (Good Medical Practice published by the General Medical Council – 3 edition,
May 2001). Failure to comply with this requirement may result in a complaint to the GMC.

Section P - Signature
I confirm that I have fairly and honestly completed this application by myself, without significant help or input from
other sources. I understand that my application form will be checked, and if it is subsequently discovered that any
statement is false, misleading or copied from another source, or that I have withheld relevant information, particularly
on criminal convictions and fitness to practice, my application may be disqualified and / or my employment
terminated. This may result in a referral to the General Medical Council / General Dental Council or other relevant
professional body.
I understand that employment offered in this training programme is subject to satisfactory Occupational Health
clearance and subject to the information provided on the application form or any other document being correct
The Data Protection Act 1998 requires us to provide you with certain information and, in certain circumstances, to
obtain your consent before processing data about you. Processing includes: obtaining, recording, holding, disclosing,
destruction and retaining information.
The information that you provide on this application form will be processed in accordance with the Data Protection
Act 1998, and will be used for recruitment and if you are successful, will form part of your training record at the
Deanery.
If you are appointed, the information will be passed to your employing trust. Information relating to your name,
contact address, email address, date of birth, GMC/GDC registration, specialty, grade and your photograph will be
passed to the Department of Health & NHS Employers for the production of an Occupational Health Smartcard.
I understand and agree that the information provided on this form will be entered onto the Deanery‟s computer
information system and used for the Deanery‟s legitimate business.

Please do not complete this signature electronically. If you are invited to interview you will be asked to sign a
                                          paper copy at that stage.

Signature                                                                                       Date




                                                                  26
                                                                       THE LONDON DEANERY

                                         SHORT-LISTING SCORE SHEET – DENTAL FOUNDATION YEAR 2 POST

NB All entry criteria must be met by date of shortlisting committee
ENTRY CRITERIA                                                    Assessed In Section
                                                                                             YES/NO                 ESSENTIAL CRITERIA
Eligible for registration with the GDC                                       C
                                                                                             To be confirmed        Has this applicant scored a 0 in any     YES / NO
                                                                                             by Deanery             of the essential criteria?
BDS (or equivalent)                                                                                                 If an applicant scores 0 in any of the essential criteria,
                                                                             H                                      the application must be discussed at the shortlisting
Will have completed VT by time of appointment or have a                       I                                     committee
Performers List Number
Basic Life Support within 1 year                                             K


ESSENTIAL CRITERIA                             Maximum Score
                                               (Range 0 –4)    Applicant‟s   Assessed in    DESIRABLE CRITERIA                                 Maximum Score        Applicant‟s
                                                               score         this Section                                                      (Range 0 – 2)        score
                                                                             of the
                                                                             Application
                                                                             Form

Demonstrates insight into his / her clinical         4
deficiencies                                                                      K

Demonstrates understanding of the value              4                            K&L
of the DFT Y2 year
Clinical Governance / Management                     4                             L
Understands Value of Vocational Training             4                             L
in relation to career progression
                                                                                  H         Other degrees eg: BSc                                       2



Total number of points (Maximum - 18)                              points scored ______________________
Any attributes which are evaluated on the basis of the application form alone may be further explored at the interview

				
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