Application for Employment Part 2 of 2 Application

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Personal Details
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Eligibility to work in the UK and Ireland

If invited to interview you will be required to bring with you the original documentation as evidence of your entitlement to work in this country. Failure to do so will invalidate your application

Educational Details
If none, enter 'none'
If none, enter 'none'
Employment History

Last Five Periods of Employment Prior to Above (most recent first)


Please note that prior to making an offer of employment, we are required by law to verify documentary evidence (and maintain copies for our files) regarding a candidate’s eligibility to work in the UK. This applies to all candidates regardless of nationality/origin.

Under the Rehabilitation of Offenders Act 1974 (Exceptions), (Amendment) Order 1986, it is compulsory to declare  every previous conviction whether spent or not when applying for any employment that has access to or substantial  contact with children, elderly people, the sick, and people with physical or mental disabilities.

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Further Information

Drawing on your experience/skills/abilities/qualifications (if applicable), please demonstrate why you feel you would be suitable for this post.


Please give names, addresses and telephone numbers of two professional referees (one must be your present or, if not currently working, your most recent employer). References from relatives are not acceptable

Referees, for shortlisted candidates, will be approached before interview unless you indicate otherwise by ticking the box provided. The Practice also reserves the right to contact any previous employer

Referee 1: Current or Most Recent Employer

Referee 2: Employer, prior to current or most recent employer

Disclosure and Barring Servoce

Any job role that requires an individual, in the course of their normal duties, to provide care for, training, supervision, access to confidential records or being in sole charge of children or vulnerable adults will require a Disclosure and Barring Service (DBS) check to be undertaken.

In accordance with the Children and Social Work Act 2017 you will be required to undertake a DBS check in order to accept a position at Church Stretton Medical Practice.


I confirm that all the information given on this application form is true and complete, I understand that any falsification, deliberate omission or misleading information may disqualify my application or lead to the termination of any employment contract offered.

If my Application for Employment is successful, I agree to undergo a medical examination if this is required to ensure my suitability to carry out my duties and for provision of an occupational health scheme or private medical insurance scheme. I have given my explicit consent freely.

Privacy Consent

This form collects personal information about you. Please read our Privacy Policy to discover how we protect and manage your submitted data.


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