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1
What's your full name?* This field is required.
First Name
Last Name
2
What's your email?* This field is required.
example@example.com
3
What's your phone number?* This field is required.
4
Town or city* This field is required.
5
Right to Work (RTW) Status* This field is required.We ask this to understand what roles you are eligible for.
Please Select
Please Select
• British Citizen
• Irish Citizen
• ILR (Indefinite Leave to Remain)
• Pre settled Status
• Settled Status
• Skilled Worker Visa
• Health & Care Worker Visa
• Student Visa
• Graduate Visa
• Dependent Visa
• Other – please specify
6
Please specify* This field is required.
7
Professional Registration* This field is required.
Please Select
Please Select
NMC – Adult Nurse (RNA)
NMC – Children’s Nurse (RNC)
HCPC – AHP Registration
Registration in progress
No UK registration
8
Registration Expiry Date
Date
Year
Month
Day
9
Current Employer Name* This field is required.
10
Employer City/Town* This field is required.
11
Current Department* This field is required.
Please Select
Please Select
• Theatre Scrub
• Critical – Anaesthetics
• Theatre Recovery
• Critical Care
• Other
12
Please specify* This field is required.
13
Experience in Current Role – Start Date
Date
Year
Month
Day
14
Have you achieved a step on the Framework for Adult Critical Care Nurses?* This field is required.What level do you have?
Please Select
Please Select
Level 1
Level 2
Level 3
Level 4
None
15
Preferred Work Pattern* This field is required.
Please Select
Please Select
Full time
Part time
Flexible
16
Shift Preference* This field is required.
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Please Select
Days
Nights
Mixed / Rotational
17
Contact and Data Use Consent* This field is required.We will only use your details in line with our privacy policy
I consent to being contacted about suitable roles
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