Physiotherapy Candidate Questionnaire HiddenDepartment Candidate Name(Required) First Last Mobile Phone(Required)Email(Required) Band(Required)Please Select...2345678Specialty(Required)Please Select...PhysiotherapyPlease summarise your career over the last 3 years(Required)Have you ever been disciplined, suspended, or are you currently under investigation by an NHS Trust, HCPC 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 manual therapy?(Required)You are asked to carry out an assessment on a patient who is not able to consent. What should you do?(Required)Please outline your understanding of Clinical Governance.(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)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) 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 NameThis field is for validation purposes and should be left unchanged.
