NHS Scotland Application Form

First save this form under another name. To complete this form, point your mouse arrow on to the highlighted portions OR use your tab key to move between the highlighted fields and start typing. You must complete the application form in full as we do not accept CVs. PART A Application for (Job Title): Job Reference No: Ambulance Trainee Technician Location: Glasgow - Scotland Candidate ID No:

No applicant will be unfairly discriminated against. We are particularly alert to eliminating discrimination on account of age, cultural/religious/political belief, disability, ethnicity, gender, race, relationship status, sexual orientation, and/or Trade Union membership or stewardship. Only 'Part C' of this form will be made available to short-listing panels. Parts A, B and C would then be used by the interviewing panel if you are selected for interview. Personal Details Surname: Name known: Address:
Belcari
Belcari Bernardo

Forename:

Bernardo

Title:

via delle grazie n 5, Santa Maria a Monte (PISA)

Post Code: Contact Telephone Numbers: +390587707011 Evening: Email:

+39 340-1624523
bernardo.belcari@hotmail.it

56020

Day: Mobile:

+39 340-1624523

3401624523

If we need to, the best way for us to contact you is by: Work Permit Do you need a work permit to take up this post? Working in the UK Are you eligible to work in the UK?

email or skype (bernardo.belcari)

Yes Yes




No No

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NHS Scotland Application Form

Job Reference No: Candidate ID No: Declarations

PART B

Convictions NHS Scotland is exempt from the 1974 Rehabilitation of Offenders Act (Exclusions & Exceptions) (Scotland) Order 2003. This means that unless stated in the job description, person specification or application pack, you must tell us about any previous convictions either classed as spent or unspent. If you are offered employment, any failure to disclose such convictions could result in dismissal or disciplinary action. Any information you give will be considered only in relation to the post for which this application form refers. Information will be verified by Disclosure Scotland for relevant posts. I declare that I have:

 (a) No previous convictions

(b) Previous convictions details of which are:

Please read the following statements. You will be asked to sign a declaration if you are appointed: I have completed Parts A to D of this application form and the details I have supplied are, to the best of my knowledge, true and complete; I understand that if appointed to this post the information on this form will be kept as part of my personal file record; I authorise you to obtain references to support this application if I am identified as a preferred candidate; I understand that details of educational qualifications, membership of professional bodies and referee reports may be verified through the establishments and individuals I have indicated; I consent to my details being kept confidentially and used for specific and lawful purposes as specified in the Data Protection Act 1998; I declare that I have no previous convictions, or have identified any I have above.

Read, agreed and understood (check box)

Date:

17/12/2013

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NHS Scotland Application Form

Application for (Job Title):

Ambulance Trainee Technician

PART C Job Reference No: Candidate ID No:

Location: Glasgow - Scotland Qualifications Achieved Subjects

1) College certificate

Type of Qualification eg. Standard Grade, GCSE, Higher, BSc

Grammar School (Science Course Diploma - at GCSE level) Liceo Scientifico "XXV Aprile" Pontedera

Grade Achieved
Graduated

2)Bachelor of science of nursing Registered Nurse number IP003978 - IPASVI college of Pisa

Accademic Registered nurse

3) 1st postgraduate Master in EMERGENCY NURSING

ALS & BLS-D according to 2010 AHA guideline (American Heart Association) Anaesthesiology, management of the critical patient.

Postgraduated

4) AED Operator (Automatic External Defibrillator)

EMT basic level (1st) in Italy according to 2010 AHA guideline (American Heart Association)

EMT-B qualification

Qualifications Currently Studying or Working Towards Type of Qualification Subjects eg. Standard Grade, GCSE, Higher, BSc

Grade Anticipated

Date Anticipated

Membership of Professional or Regulatory Bodies Full name of organisation(s) Registration Number

Federazione Nazionale Collegi IPASVI - National Federation of IPASVI College IP003978

Renewal Date
Registered lifelong.

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NHS Scotland Application Form

Job Reference No: Candidate ID No: Present (or most recent) Post Job Title:
Psychiatric Nurse

PART C

Grade: Registered Nurse

Date of Starting Grade:

Employer: Borgo dei Colori - Via vecchia Pisana Livornese 13, Lorenzana (PISA) Dates of Employment: From:
30/08/2013

To:

31/12/2013

Reason for Leaving (if applicable): I want to become an ambulance trainee technician in Scotland Notice Period: Current Salary:
3200 euros/month

Role Purpose / Summary of Responsibilities

Management of the psychiatric patient and his complications

Employment History Start with your most recent employment first and work down the page. If a job supports the position applied for, please say more about it in your Application Support Statement. Job Title Employer Date From Date To
Psychiatric Nurse RSD "Borgo dei Colori" 30/08/2013 31/12/2013

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NHS Scotland Application Form

Job Reference No: Candidate ID No: Referees

PART C

Your referees will include your present (or most recent) employer. Please identify below the person in your organisation (for current NHS staff this is your direct line manager) who is authorised to confirm your employment and the details given in your application. Please identify a second referee who may have closer knowledge of your skills, knowledge and abilities and who may offer opinion on your suitability for this post. You should not use family members or friends. Our pre-employment screening also includes, where appropriate, health and fitness for work, criminal records, qualifications and professional registration. Note that references will only be taken up for Preferred Candidates following interview. Name 1: Address:
Jessica Giusti

Designation:

Boss

Via vecchia Pisana Livornese 13, Lorenzana (PISA)

Post Code: Telephone: Name 2: Address:

348-2473616

56020

Email: Designation: Advisor Post Code:

Simone Baldanzi
PISA

56020

Telephone: Disability

3382130215

Email:

s.baldanzi@usl5.toscana.it

The Disability Discrimination Act 1995 and Amended Regulations 2005 defines disability as follows: any physical or mental impairment which has a substantial adverse effect on a persons ability to carry out normal day to day activities. NHS Scotland is Positive About Disabled People, and as such we provide job opportunities for disabled people. NHS Scotland operates a Job Interview Guarantee (JIG), which means that if you have a disability, and meet the minimum criteria outlined within the person specification, you will be guaranteed an interview. However, some disabled people prefer not to take this option, so please tick your preference if you are a disabled candidate. Do you want to participate in the guarantee scheme? Yes No

Please specify any special requirements you require if attending for interview, eg. Induction Loop, Wheelchair Access, Signer Driving Licence (see Job Description - only complete if a driving licence is essential) Do you have a driving licence? If yes, which categories are you entitled to drive, eg. B, BE, C Yes
B and C

No

Page 5

NHS Scotland Application Form

Job Reference No: PART C Candidate ID No: Statement in Support of Application please tell us your personal qualities, skills and attributes, experience and any major achievements and show how they match those needed for this job.
Im a simple man, my best quality is the honesty and the sincerity. Im 23 years old and since i was 18 eight old ive been on the ambulance services in italy as volounteer; Emergency medical services in Italy currently consist primarily of a combination of volunteer organizations providing ambulance service, supplemented by physicians and nurses who perform all advanced life support (ALS) procedures. Ive obtained an accademic title in Italy for emergency nurse, after have achieved the title for emergency nurse. Im an active volounteer of the Italy emergency medical system, and my dream is always been becoming a Paramedic. Ive chosen Scotland for my future because its a beatiful country and you have the possibility to realize yourself on the aspect of job career, especially both a personal and professional point of view. I am able to learn fastly the habits, the customs of the place where i stay. I am a person who gives respect to everyone, i do not have any type of discrimination. I play piano since i was 14, and guitar since i was 17. I like Glasgows way of life, and I think that the quality of life is beatiful as Italy. I know that my written and spoken english is quite bad, but im applying to study english at British School located in PISA.

I hope you will consider me for a job interview.

Where did you see the Advertisement for this Post? Newspaper (which one?) Professional Journal (which one?) Vacancy Bulletin SHOW (NHS Scotland Website) Job Centre Plus Ive asked informations directly to Personnel (Scottish Ambulance Services)  Other (please specify)

Page 6

NHS Scotland Application Form

Job Reference No: Candidate ID No: Equal Opportunities Monitoring

PART D

We want to ensure that our job opportunities are open to all. The only way we can ensure there is equal opportunity is to monitor applications we receive and compare the profile of people who apply with those appointed. Therefore this form asks you for your ethnic origin, gender, disability, religion, sexuality and age. The information you provide in this part of the form (Part D) is confidential and is not used in the selection process. It will be separated from the rest of the form when we receive it. 1) If you are currently an employee of this NHS Board, will getting this job be a promotion? Yes 2) You are: Female Male No

3) Have you undergone, are you undergoing or do you intend to undergo gender reassignment? For example, this includes having changed your sex (gender)? Yes I am Yes No

Prefer not to say

05/12/1990

4) What is your age?

23

years old, and my date of birth is:

5) Do you have a physical or mental health condition or disability that: has a substantial effect on your ability to carry out day to day activities? has lasted or is expected to last 12 months or more? No

Prefer not to say Physical impairment Sensory impairment

If you answered yes please tick if it is either of the following:

Learning Disability Long standing illness Mental health condition Other (please describe):

Again, if yes, please describe any particular arrangements you would need for your work location:

(Continued on next page)

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NHS Scotland Application Form

Job Reference No: PART D Candidate ID No: 6) What is your ethnic group? Choose one section from A to F, then tick the appropriate box to indicate your cultural background A: White Scottish Irish Other British


B: Mixed

Any other White background Any mixed background

C: Asian; Asian Scottish; Asian British Pakistani Indian Bangladeshi

Chinese

Any other Asian background

D: Black; Black Scottish; Black British Caribbean African Any other Black background E: Other ethnic background Any other background F: Prefer not to answer 7) To which religion, religious denomination or body do you actively belong? (Christianity) - Church of Scotland Hinduism Sikhism Judaism Islam No religion (none)

(Christianity) - Roman Catholic Christianity (other) Other faith / belief Buddhism Prefer not to answer

8) Which of the following best describes your sexual orientation? Bisexual Gay Man Lesbian/Gay Woman Prefer not to answer

Heterosexual Other

Page 8

Application Pack Core Competency Sheet

N.B. This sheet will be pulled out for short-listing purposes. It is therefore necessary for you to re-enter the post details below. Please do not enter your name on this sheet.

*Job title *Department/Division

Candidate reference (leave blank for office use) *Vacancy reference

Statement in support of application

Please read the job description, KSF outline and in particular the core competency guidance sheet given and enter evidence of your skills, achievements and experience against each competency in a separate box below. You should only give details which are relevant to the specific post you are applying for. This section will help us to decide if we should short-list you for interview. Leave blank for office use.

1. Communication (Assessed against KSF level 3)

2. Personal and people development (Assessed against KSF level 2)

3. Health, Safety and Security (Assessed against KSF level 2)

4. Service Improvement (Assessed against KSF level 1)

Application_pack_core_competency_sheet_Tech.doc5

5. Quality (Assessed against KSF level 2)

6. Equality and Diversity (Assessed against KSF level 1)

Scale:
Yes Clearly understands the criteria required for this competency No - Does not clearly understand criteria required for this competency Maybe Some understanding of the competency

Shortlist:

Yes No Hold

Application_pack_core_competency_sheet_Tech.doc5

Candidate No. _______

(office use only)

PLEASE INDICATE WHICH REGIONS, IF SUCCESSFUL, YOU WOULD LIKE TO BE CONSIDERED FOR:

NORTH HIGHLANDS GRAMPIAN WESTERN ISLES NORTHERN ISLES

EAST CENTRAL TAYSIDE FORTH VALLEY FIFE

SOUTH EAST LOTHIAN SCOTTISH BORDERS

WEST CENTRAL LANARKSHIRE GREATER GLASGOW DUNBARTONSHIRE

SOUTH WEST AYRSHIRE ARGYLL & CLYDE DUMFRIES & GALLOWAY