Candidate Questionnaire

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Department

Mobile Phone(Required)

Email(Required)

Grade(Required)

Specialty(Required)

Please summarise your career over the last 3 years(Required)

How do you keep yourself professionally updated?(Required)

Have you ever been disciplined, suspended, or are you currently under investigation by an NHS Trust, GMC or other employer (including other agencies) – if yes, please give details *(Required)

Why have you chosen to register with Total Assist? *(Required)

Tell me about a recent occasion when you were under pressure and handled it successfully. - What was the situation? - What actions did you take? - What was the outcome?(Required)

Describe a clinical situation where you require input from other professionals.(Required)

You prescribe an incorrect dose of a drug, which gets administered. What process would you follow?(Required)

What steps would you take, going forward if you become aware of an incident or complaint, which you were involved or implicated in?(Required)

Please outline your understanding of Clinical Governance.(Required)

Thinking about a recent difficult situation you’ve had with patient’s relatives – How did you handle this and the outcome(Required)

Candidate Signature(Required)

Date of Candidate Signature(Required)

Place of Interview

Interviewers Grade/Band

Interviewer Signature

Date of Interviewer Signature