Nurses Candidate Questionnaire Candidate Name(Required) First Last Mobile Phone(Required)Email(Required) Band(Required)Please Select...23456788a8b8cSpecialty(Required)Please Select...A&ECritical CareHealthcare Assistant (HCA)MidwiferyODPPaediatricRGNRMNTheatresPhlebotomyDo you have Indemnity Insurance that covers locum work? If yes, this will need to be sent over Yes No 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, NMC 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)What is your understanding of the term 'person-centred care’ (often referred to as patient centred care)?(Required)Courage and Commitment are two examples of the SIX nursing core values (often referred to as the 6 ‘C’s). What are the remaining FOUR of the 6C’s?(Required)There are SEVEN rights of medication administration including the right to refuse? Can you identify them.(Required)If a patient is showing signs of an allergic reaction during or following the administration of a drug, what course of action should be taken?(Required)How do you manage patients showing signs of verbal aggressive/ challenging behaviour?(Required)Candidate Signature(Required)Date of Candidate Signature(Required) DD slash MM slash YYYY Interviewer Name First Last Place of Interview Interviewers Grade/Band Interviewer SignatureDate of Interviewer Signature DD slash MM slash YYYY Did 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
