Internal Appraisal Form TLA Applicant Name(Required) First Last Date of Birth(Required) DD slash MM slash YYYY Professional Registration Number(Required)Start Date of shifts(Required)Trust name(Required)Location(Required)Do you have any concerns with The Locum Agency?(Required) Yes No Do you have any concerns with the trust you are working in?(Required) Yes No Do you require anything additional?(Required) Yes No 6 month appraisal summary completed date(Required) DD slash MM slash YYYY Signed by Candidate:(Required)OFFICE USE ONLY:Do The Locum Agency have any concerns in regards to the candidate? Yes No Completed by: First Last Position:Signed by The Locum Agency:Date DD slash MM slash YYYY
