Before filling in this form, please read the relevant candidate pack and make sure that you meet the eligibility requirements and that you are not excluded from applying.

If you have any initial queries or need any reasonable adjustments made, please contact Rhiannon Smith at [email protected]. This information form is available in other formats on request, such as braille or large print.

If you would like an informal conversation with a Council colleague, please get in touch with xxx to arrange at [email protected]

To complete this application, you will need:

• A statement on why you are suitable for the role (no more than two pages). Please make sure you say how you meet the competencies set out in the relevant Candidate Pack.
• Your CV (no more than three pages).

You can upload the required documents (in pdf or Word format) at the end of this form. All applications will be acknowledged.

Please give the name, address, telephone number and email address of two professional referees. We will only approach your referees if you are shortlisted.

Please note that we will take references before interview – please ensure that your referees are aware and will be able to respond.

In the past five years have you held any of the following?

• Any appointment made by or on behalf of Ministers or any other public appointment (including any role on any public or NHS body).

• Any Government role, health and/or social care board role or regulatory roles. This would include, for example: roles in the Department of Health and Social Care, Welsh, Northern Ireland or Scottish Government; any role working for the four Chief Nursing Officers in any of the four countries, or for bodies such as NHS England, NHS Education Scotland, Health Education and Improvement Wales, Regulatory and Quality Improvement Authority, Northern Ireland or the Care Quality Commission.

Before answering:

• please read carefully the eligibility requirements and grounds for disqualification which would exclude you from being appointed set out in section 5 before you complete the following section.
• please also think about your social media presence or any other information about you that may be in the public domain.
• failure to disclose such information could result in your application or your appointment being terminated.

Before answering:

Please consider carefully whether you, or a close family member, has any professional, business or personal interests that might be relevant to the work of the Nursing and Midwifery Council, which could lead to an actual or perceived conflict of interest or loyalty which may call into question your integrity or independence.

Please read the separate guidance on conflicts of interest very carefully before completing this section. If you need any further advice or guidance please raise this before you complete the form with XXXXX at XXXXXX, who will consult the NMC as necessary.

Please note that any interests declared will not necessarily prejudice your application. We may need to discuss any potential conflicts with you and/or the Selection Panel may explore interests at interview.

Please note, answering ‘Yes’ to any of the following questions may mean you are not eligible.

Have you at any time been subject to any investigation or proceedings concerning your fitness to practise by any licensing body, the final outcome of which was:

• your erasure from a register held by the licensing body or a decision that had the effect of preventing you from practising the profession licensed or regulated by the licensing body.
• your suspension from a register held by the licensing body and that suspension has not been terminated.
• a decision that had the effect of only allowing you to practise that profession subject to conditions and those conditions have not been lifted.

Do you have an unspent conviction for contempt of court or an offence involving: dishonesty or deception; terrorism; money-laundering; bribery; contravening a Charity Commission Order or Direction under s.77 of the Charities Act 2011; misconduct in public office, perjury, or perverting the course of justice; or for aiding, attempting or abetting any of the above offences?

Final interviews

Interviews will be held in person in London. Should you be shortlisted for an interview please confirm whether you are available to attend on the following date:

We are committed to making reasonable adjustments to make sure that our processes are accessible for everyone, in line with the Equality Act 2010. If you have a disability or injury please tell us if you need any reasonable adjustments. This might include receiving our information in an alternative format (for example, large print or audio).

Please answer all the questions by clicking in the appropriate box. There is a ‘prefer not to say’ option for all of the questions. This information will be treated with the strictest confidence.

Do you look after, or give any help or support to, anyone because they have long-term physical or mental health conditions or illnesses, or problems related to old age? Please exclude anything you do as part of your paid employment.

What was the occupation of your main household earner when you were about aged 14?