• Application Form (Doctors)

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  • Personal Details

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  • Employment Requirements

  • Right to Work in UK

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  • Indemnity Insurance

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  • Qualification / Training

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  • Employment History

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  • Training

  • References

    Please provide details of at least two professional references. One reference must be from your most recent employer and another one from your previous employer
  • I hereby give consent to Flamelily Healthcare to contact the professional referees that I have listed above or mentioned in the CV, to obtain professional reference for registration and clearance for locum work with NHS.
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  • Availability of Work

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  • Health

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  • I give my consent to The Flamelily Healthcare to obtain my personal occupational health records and/or similar data from third parties such as NHS trusts or GP doctors for registration and clearance for locum work with the NHS.
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  • Professional Conduct

  • Rehabilitation of Offenders ACT

    Convictions will not necessarily be a bar to obtaining a post. However, because of the nature of the work for which you are applying, this post is exempt from the provisions of Section 42 of the Rehabilitation of Offenders Act 1974. Applicants must declare information about convictions, cautions, reprimands and final warnings, for which other purposes are “spent” under the provisions of the Act.
  • Emergency Contact Details

    Please provide details of the person you would like to be contacted in the event of an emergency
  • Payroll Details

  • Work Time Directives

  • Data Protection

  • Declaration

  • Clear
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  • Should be Empty:
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