STEP 1

Key Questions

STEP 2

Your details

STEP 3

Work history

STEP 4

Upload documents

STEP 2 of 4 - Your details

 

Please take a few minutes to complete the form below. You will need to upload clear scanned or photographed copies of the following documents:

 

1. Proof of address documents (bank statements or utility bills dated within the last 90 days) 

2. Copy of your up to date passport and driving license (if you have one).

3. Evidence of your NI Number (payslip or NI Certificate).

4. Copy of your Disclosure & Barring Service Certificate (DBS Update Service).

5. Copy of your NMC or HCPC Certificate (date of entry).

6. Copy of your Immunisation Record

7. Copy of your Occupational Health Certificate (if available).

8. Copy of your up-to-date CV.

9. Two up to date professional references.

10. Revalidation date.

 

PLEASE NOTE: The images must be clear and legible and show all of each document. Illegible or incomplete documents will be rejected.
 

About you

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Upload evidence of NI number

Disclosure and Barring Service Check

Are you registered for the Disclosure and Barring Service update service?
Upload copy of D&B Certificate

PLEASE NOTE: Not being registered with the DBS Update Service may impact on your application. Register here.

Skills and qualifications

Professional Registrations
Upload NMC Statements of Entry (if applicable)
Do you have an IV Competency Certificate?
Upload copy of IV Comp. Cert.

If you do not have an IV Competency Certificate, click here to request an online 30 minute training session.

Do you have a Critical Care Certificate?
Upload copy of Critical Care Cert.
Do you have Academic Transcripts with module score over 30?
Upload Academic Transcripts
Please indicate the areas of clinical experience you have had within the past 2 years
Qualifications
Have you been registered with Harley Medical Services previously?