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Please have all relevant documents and information handy and provide all relevant details by filling this form accurately.

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Relationship to applicant By signing this form you are consenting to JayTams Ltd. carrying out relevant checks on your eligibility to work status with the UK Home Office. Next

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What setting do you work in? Secondary care (e.g. Hospital)Primary care (e.g. GP surgeries)Private care

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As a registered member on the NMC Professional Register you should be aware at all time of the correct process for administering medications and ensure that you follow this process to protect the patient and yourself at all times. If you are involved in an administration error you must also ensure that you follow the correct safety process for reporting the incident and preventing any harm to the patient. Following the 5 R’s of medication administration will keep both your patients and your practice safe, as a registered professional, you are always accountable for your actions and omissions.

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Are you currently under investigation by your designated body (see revalidation and appraisal), professional body or any other organisation i.e. NHS Trust or private practice? YesNo Have you ever been under investigation by your by your designated body (see revalidation and appraisal), professional body or any other organisation i.e. NHS Trust or private practice? YesNo Do you have any restrictions to your professional practice or have restrictions that would prevent you from working for any NHS Trust or Healthcare body? YesNo if You answered yes to any of the above, please provide more details Do you work with adults, Paediatrics or both? AdultsPaediatricsBoth You confirm that by submitting your details you have read and understood our privacy policy. We will not share your personal data except with those categories of third parties identified in our privacy notice.

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