TLA F2F form Place of Interview(Required) Name of Interviewer(Required) First Last Interviewer Email Address(Required) Date of Interview(Required) DD slash MM slash YYYY Applicant Name(Required) First Middle Last Applicant Maiden Name First Middle Last Date of Birth(Required) DD slash MM slash YYYY Availability to start work(Required) DD slash MM slash YYYY I confirm that I give my permission to The Locum Agency to share my data with Total Assist Recruitment(Required) Yes What specialities do you want to work in ?What is your availability over the next 6 months ?What are your 3 most important factors when considering a role ?What areas do you wish to work in ?What is the main reasons you would like to register ?Have you had any complaints by patients, relatives or other members of staff against you? If so; when, what about and how were these resolved?Are you computer literate? (Word processing, PowerPoint, internet etc.)By signing this document, I confirm that i have met a Locum Agency representative for a face to face interview and i have had my documents verified.Applicants Signature(Required)Interviewers Name First Last SignatureDid the candidate have a good command of the English language ? Yes No Was the candidate pleasant and polite ? Yes No Was the candidate courteous and helpful? Yes No Are you happy to offer this candidate work on the basis of this interview? Yes No
