Total Cumulative Months *‘if it is not clearly evident from the Title of Post that it satisfies the eligibility criterion of Specialist in Orthodontics, please provide further detail in the box below: ADDITIONAL EDUCATIONAL ACHIEVEMENTS Please include second level and any additional / third level educational achievements: Dates From MM/YY To MM/YY Educational Institution Conferring Body Course of Study Qualification Achieved Grades Achieved
Professional Relationship to candidate: Postal Address: Telephone Contact Details: Mobile: Landline: Email Address: ______________________________________________________________________________________ 2. Name and Job Title of Referee: Professional Relationship to candidate: Postal Address: Telephone Contact Details: Mobile: Landline: Email Address: ______________________________________________________________________________________ 3. Name and Job Title of Referee: Professional Relationship to candidate: Postal Address: Telephone Contact Details: Mobile: Landline: Email Address: Equality Monitoring Form Candidates please note this data is for administrative records only, and does not form part of the information submitted to the interview board, or any portion of the appointments process. Candidate Name Date of Birth Nationality Gender Male Female Applicant Checklist - Important We recommend that you check your application form carefully to ensure that you have included / clearly illustrated / answered:
1 Mobile Telephone Number Email Address Postal Address Mandatory 2 That the information you have provided with regard to eligibility to apply on pages 4 and 5 shows clear dates e.g. DD/MM/YY, education courses, job titles, college names, qualification titles 3 Supplementary Questions 1 – 5 (Each question must be fully completed to ensure eligibility to progress in this campaign) 4 Work Permit Documentation (if relevant to non EU applicants) (Please refer to Appendix 2 of the Additional Campaign information document for details of documentation required) 5 That your application is submitted by the closing date and time of Wednesday 9th December 2015 at 12 noon 6 That you have downloaded the job specification and Additional Campaign Information for future reference. If all required details / documentation (as above) are not submitted with your application we will be unable to process your application to the next stage of the process i.e. short listing / interview Appendix 1 SUPPLEMENTARY QUESTIONS Information on completing the Supplementary Questions: In the supplementary questions section, you are required to describe some of your personal achievements to date that demonstrate certain necessary skills and qualities required for the position of Specialist in Orthodontics. The skills and qualities are outlined in the Questions Areas 1 – 4. All question areas must be completed and remember that you will be questioned on all areas at interview. The instructions below will help you to complete your answers, but you should also consider these instructions when you are preparing for interview. For each Question Area 1-4, you are a description of a skill or quality. You are then asked to describe a situation, from your own experience, which you think is the best example of what YOU have done which demonstrates this skill or quality. It is essential that you describe how you demonstrated the skill or quality in question. The information you present here may form part of a ranking exercise process, and may also be used to help structure your interview, if you are invited to one. A ranking exercise may apply based on the information you provide in your application form. This means that a ranking board will “rank” applicants based on information put forward in the supplementary questions section of your application form. Interviews may be held on a phased basis, inviting applicants to interview based on the position held in the ranking exercise. A primary panel will be formed of candidates successful in the first phase of interviews. If subsequent interviews are held candidates successful at these interviews will be added to the end of the primary panel and will be listed with a lower order of merit.