TLA Pharmacy Candidate Questionnaire

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Department

Candidate Name(Required)

First Last

Mobile Phone(Required)

Email(Required)

Grade(Required)

Specialty(Required)

Please 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, GPHC or other employer (including other agencies) – if yes, please give details(Required)

Why have you chosen to register with The Locum Agency? *(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 Medicines Act 1968?(Required)

You are asked to prescribe medication which is not clearly documented within the patients notes and medical record. What should you do?(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 Name(Required)

First Last

Candidate Signature(Required)

Date of Candidate Signature(Required)

Interviewer Name

First Last

Place of Interview

Interviewers Grade/Band

Interviewer Signature

Date of Interviewer Signature

Did the candidate have a good command of the English language?

Yes

Was the candidate pleasant and polite?

Yes

Was the candidate courteous and helpful?

Yes

Are you happy to offer this candidate work on the basis of this interview?

Yes