Event Clinician Application Form V2

Event Clinician Application Form

Nexus EMS provide event medical cover nationwide. We offer flexible self employed opportunities for clinicians to work at leading events.
Personal Details
Name*

First NameLast Name
Mobile Phone Number*
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityCounty

Postal Code

Position & Experience

We require all registered health care professionals to hold a NHS contract to meet our eligibility.
Position Applied For*
Please note you must already be qualified. We currently have no vacancies for trainees.
Do you currently hold a NHS contract?*

YESNO
Current Employer*

Driving

You will be sent a separate link to our driving licence check service. We use software to check each staff member's driving licence every 3 months as part of our gold standard compliance system.
Do you hold a full UK driving licence?*

YESNO
Do you hold a C1 rating on your licence?*

YESNO
Do you hold a NHS recognised blue light driving qualification (IHCD or FQ Only)?*

YESNO
How many points do you have on your licence?*
You agree to sign up to regular driving licence checks*

YESNO

DBS

It's a requirement of our employment that each member of staff has an Enhanced DBS on the DBS update service. This is because we use software to regularly check DBS certificates as part of our gold standard compliance. If you don't have a DBS on the update service a fee of £55 will be charged to complete a new DBS check.
Do you hold an Enhanced DBS Certificate on the Update Service?*

YESNO
DBS Certificate Number
Do you have any convictions or cautions that would not currently be filtered by the Disclosure and Barring Service (DBS)?*

YESNO
If Yes, provide details.
DBS Certificate

ONLY required if on the update service and NOT blank
Cancelof

References

Although working part time its a requirement of CQC registration to collect references from all staff. References must be Professional and not personal and should be from an official emails address and not a personal one.
Reference 1 - Ideally your last employer (or current if able)
Full Name*
Job Title*
Email*
example@example.com
Phone Number*
Reference 2
Full Name*
Job Title*
Email*
example@example.com
Phone Number*

Documents

Please upload relevant documents here. If not immediately available please forward to compliance@nexus-medical.co.uk
Core Qualification

Cancelof
Emergency Driving Qualification

Cancelof
Driving Licence (Front & Back)

Cancelof
Current CV

Download from NHS Trac is also acceptable.
Cancelof
Current NHS Contract

Cancelof
Occupational Health EPP Clearance

Cancelof
Other Relevant Qualifications or Documents (Multiple Allowed)

Cancelof

Finally
Please detail any further relevant information and/or personal statement
Thank you for your interest. Following submission a member of our team will be in contact with you.
Should be Empty:

Event Clinician Application Form