Application Form

Personal Information

(Please note: Your name should be in full, as appearing on the NMC register and passport)

Next of KIN

Professional Details

Right to work in the UK

I Confirm I am eligible to work In the UK on the following basis:

Are you an EEA National/ Citizen?*

Fitness to practice

Have you been or are you currently subject to any fitness to practise proceedings by an appropriate licensing or regulatory body in the UK or any other country ?*

Employment/Education History

Please submit your full Employment/Education history via a copy of your current CV. In your CV mention below things:*

  • Please supply details of your work history from school to date
  • Please explain any gaps of 2 weeks or more
(Allowed Type(s): .pdf, .doc, .docx)

Rehabilitation of offenders act

Have you been convicted of a criminal offence, been bound over or cautioned or are you currently the subject of any police investigations, which might lead to a conviction, an order binding you over or a caution in the UK or any other country?*

Disclosure and Barring service

All public and private organisations request that an Enhanced Disclosure be obtained for all healthcare personnel acquired from the Disclosure and Barring Service or Disclosure Scotland through Your Nurse

Do you have an Enhanced Disclosure and Barring Service certificate*

Update service*

Professional References

Please provide names and contact details of professional referees from your most recent employment, which must cover the last 5 years of employment/education. Referees must be working in senior position to yourself

GDPR declaration

In accordance with the new general data protection regulations (GDPR) we are asking you to sign this to provide consent for Your Nurse to collect and retain your information on our system.


The Working Time Regulations 1998 require Your Nurse to limit your average weekly working time to 48 hours unless you agree with Your Nurse that the limit shall not apply to you