Registered Nurse
Ref: PRI17430

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* denotes mandatory field

We would really like you to spend a few minutes providing us with some information - we promise it won't take too long. Any fields marked with a * will need to be completed before you can progress to the next page.















Details of membership of professional bodies / professional registration



Disclosure

When considering your application, in accordance with the Rehabilitation of Offenders Act 1974 and the Rehabilitation of Offenders (Northern Ireland) Order 1978, Priory Group is required to take into account relevant criminal record and other information declared which is relevant to the position being applied for. Depending on the role that you are applying for, you may be required to declare any 'spent' convictions to us prior to appointment. At this stage, please disclose all 'unspent' convictions.

Answering 'yes' to the question below will not necessarily bar you from appointment. This will depend on the relevance of the information you provide in respect of the nature of the position for which you are applying and the particular circumstances.



Any appointment to the vacancy for which you are applying may be subject to a disclosure from the Disclosure and Barring Service, Disclosure Scotland or Access NI. Please note that Priory Group abide by the Access NI Code of Practice which can be found on the Department of Justice website.

Declaration

I understand that failure to disclose information or the provision of incorrect information may result in an offer of appointment being withdrawn or in disciplinary action being taken leading to dismissal at a later date. I agree to you approaching any of my previous employers to verify my employment history.

I agree that, if I am appointed, the information may be used as part of the permanent personnel record of my employment under the Data Protection Act.