Application Form: Part 1

1. Contact information

  • Surname/Family name
  • First name 
  • Middle name(s)
  • Preferred name
  • Any other name(s) used, where different from the above
  • Title 
  • Date of birth 
  • Country of birth
  • Do you have a National Insurance Number? (Yes/No)
  • Address line 1
  • Address line 2 
  • City/town
  • Post code 
  • Country 
  • Home telephone 
  • Mobile telephone 
  • Work telephone
  • May we contact you at work? (Yes/No)
  • Please indicate your preferred telephone number (Home/Work/Mobile)
  • Email address (This is picked up automatically from your Oriel account)

Please note: Most recruitment communications will be via Oriel message direct to your Oriel account. Any communications will also be sent by email so you must provide an active email address. Please ensure you check your Oriel account regularly for messages throughout the recruitment process.

Your contact details can be updated within the “My Profile” section of your portal.

To update your profile, click on the pencil icon alongside the fields. 

2. Right to work in the UK

Your nationality – country pertaining to nationality (Select from drop-down list)

Are you a United Kingdom (UK)/Irish national? (Yes/No)

1. Equality and diversity information

The information you enter on this Equality and Diversity monitoring form will be used for monitoring purposes only and will not be used in assessing and/or scoring your application or at interview stage. This information is kept confidential and accessibility is strictly limited to individuals on a relevant basis. 

2. Monitoring information

Most public sector employers including healthcare organisations are required to collect data about an applicant. The information is used solely for monitoring purposes to ensure that recruitment policies and procedures are applied fairly and do not discriminate against individuals. We believe that it is good practice to employ a diverse workforce that reflects the communities we serve. 

The information you share with us will be used to monitor and evaluate how well we are doing in eliminating discrimination and advancing equality. The NHS is committed to the principles of fairness, consistency, meritocracy and equality of opportunity.

The Equality Act 2010 requires equal treatment in access to employment as well as private and public services, regardless of age, disability including long-term health conditions, gender re-assignment, marriage or civil partnership, maternity or pregnancy, race, religion or belief, sex and sexual orientation.   

  • Date of birth
  • Gender
  • I would describe my ethnic origin as:
  • Please elect the option which describes your sexuality
  • Do you live and work permanently in a gender other than that assigned at birth?
  • Please indicate your religion or belief:
  • Are your day to day activities limited because of a health problem or disability which has lasted, or is expected to last at least 12 months? (please include problems related to old age)
  • Are you married or in a civil partnership?
  • Are you pregnant, on maternity leave or returning from maternity leave? 

3. FOR APPLICANTS APPLYING TO NORTHERN IRELAND POSTS ONLY

To demonstrate our commitment to equality of opportunity in employment we need to monitor the community background of applicants and employees, as required by the Fair Employment and Treatment (NI) Order 1998. We therefore ask you to indicate your community background by selecting the appropriate option below.

Please note that it is an offence under the Fair Employment and Treatment (NI) Order 1998 to give false information to the Trust. 

  • Please select your community background
  • Please indicate your marital status

1. Full employment history (UK/Overseas) 

I have no employment history (Tick box)

Where experience is required for a post, ticking this box will make you ineligible.

If you completed clinical training equivalent to Foundation Year 1, before graduation from medical school, you must include this in your employment history. Remember to include any F1 / F2 posts here if applicable. If your posts are concurrent, please ensure you list each post separately stating the exact whole time equivalent for each, ensuring posts are listed in chronological order including exact start and finish dates. For consecutive posts, please ensure the end date of a post is not also the start date of the next. 

2. Employment history – data entry section 

IMPORTANT NOTE: Please use this data entry section to add/update your employment history and ensure you use the action buttons (‘Add ‘, ’Edit’, ‘Cancel ’ etc) to submit information against your record. 

Important information 

Please list all medical/dental employment from current/most recent employment history detailing back to graduation from medical/dental school. For rotational posts in Core Training programmes, please list each component post separately. Please also list posts that you are due to undertake but have not yet started, that is, future posts.     

If you are currently in employment and do not have an “end date” please put the end date as being the day before the commencement date for the post for which you are applying (as per the Applicant Guide). If you leave your current post before this date you must send details to the relevant Deanery/NHS England recruitment office. 

Important information regarding employment gaps  

The system will autogenerate any gaps in employment of longer than four weeks within three years preceding the advertised post commencing from date. Please note the following would be considered an employment gap:

  • any expected or planned career gaps between submission of the application form and the post commencing from date of the advertised post
  • any potential gaps between the end date of your last planned post and the advertised post commencing from date where you do not currently know what your employment status will be - you should - provide information about your intentions for this period
  • any periods of short-term, ad hoc or locum work greater than four weeks; where this is the case, please summarise the nature and amount of full time equivalent experience gained across any posts - undertaken during this period
  • any gaps where you have stepped out of programme with the expectation of returning such as to undertake research in a formal post or to take a career break
  • periods of leave such as maternity leave or career breaks
  • where you have less than 3 years employment history - If you have less than 3 years employment history, you must note the dates and explanation of what you were doing before your first employment post as a gap (for example Undergraduate Education).   

For each post:

  • Employer name
  • Address
  • Post code
  • Post title
  • Post type (Dropdown list of post types)
  • Specialty: (Dropdown list of specialties) 
  • Level of post (Dropdown list)
  • Less than full time (LTFT)
  • Start date  
  • End date  
  • Is this your current post?
  • Duration of post (in months)
  • Observer/Clinical attachment/unpaid post 

3. Employment gaps

Do you have any gaps in your employment of more than 4 weeks duration? (Yes/No) 

Please include career breaks for maternity leave, health etc

The answer to this question has been auto-generated based on the employment history entered above. Therefore this appears as a read-only field, you are not required to answer it. If you think that this is incorrect, please review the employment records entered previously. 

Do you have any gaps in your employment history, of more than 4 weeks duration, prior to three years before the advertised programme start date for this post?

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