DepartmentTLA
Place of InterviewLondon
Date of Interview28/08/2024
Personal Details
Applicant NameSarah Bonsu-Boateng
Date of Birth28/09/1999
Marital StatusSingle
Do you hold a driving license valid for use within the UK?Yes
National Insurance NumberPE907108A
Do you wish to register as a limited company?No
I confirm that I have received and read the Key Information DocumentYes
I confirm that The Locum Agency have my permission to request and obtain copies of payslips from my employer/ umbrella company/ personal service company and have my permission to make this available to third partiesI Agree
I confirm that I give my permission to The Locum Agency to share my data with Total Assist RecruitmentI Agree
Grade/Band6
SpecialtyNewly Qualified Pharmacist
Next of Kin
NameTheresa Yeboah
RelationshipMother
Contact Number07720001252
AddressFlat 61 Arrol House
London, London SE1 6QL
United Kingdom
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Nationality
Do you hold a British Passport?Yes
Passport Number546909153
Passport Expiry Date20/04/2027
Current AddressFlat 61 Arrol House
London, London SE1 6QL
United Kingdom
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Mobile Phone07801429776
Applicant Email AddressEmail hidden; Javascript is required.
Availability for Work
Availability to start work29/08/2024
Availability over the next 12 monthsOngoing
Which part of the UK do you prefer to work in?
  • London
Declarations

Declarations

In line with the Government legislation under the terms of the “Working Time Regulations” we recommend that your working hours should not exceed 48 hours per week (averaged over a 17 week period.)
Should you wish to waive this right, please confirm my ticking below:
  • I confirm that I wish to work more than 48 hours per week
I understand that information give on this form will be stored and handled by The Locum Agency in accordance with the Data Protection Act 1988, however, I agree that this information may be made available for audit by the relevant Government organisations e.g. CCS / CPP Framework.
Data Protection Act 1998 / The General Data Protection Regulations 2018
In relation to the Data Protection Act 1998 / The General Data Protection Regulations 2018, you agree to the processing of personal data for the purposes of the recruitment process as well as for future potential employment arrangements for the purposes of calculating your remuneration and maintaining records on attendance, health, discipline and grievances such as are necessary for the performance of your contract. For further information, please see the Information Commissioner's website ww.dataprotection.gov.uk, from which the above guidance is reproduced.
I acknowledge that I have been given a copy of the terms and conditions of service issued by The Locum Agency, which is mine to keep and further more that I have read those terms and conditions and agree to abide by them. I am not aware of any condition, medical or otherwise which would affect or limit my employment or performance, other than those declared in my Pre-employment Health Questionnaire From and I am fit for work.
I authorise The Locum Agency to disclose any convictions to any potential employers in accordance with the DBS Code of Practice and the Rehabilitation of Offenders. I declare that the details given by me on this application form are correct to the best of my knowledge and belief. I understand that if I have given any information which is false, or I withhold any relevant information, this may lead to my application being rejected, or if already appointed, to my dismissal, as well as a claim for recovery of any payments I have received, together with a claim for loss of profit to The Locum Agency.
I also give The Locum Agency Permission to apply and to check my DBS certificate on the UK DBS update service annually.
I give The Locum Agency Permission if required to conduct any relevant right to work checks Via the Government websites.
Signature
Consent I agree
Professional Details
Professional Registration Number2237583
Child Protection / Venerable Adults level 2/314/11/2023
Handling Complaints06/11/2023
Fire Procedures07/11/2023
Handling Violence & Aggression17/08/2023
COSHH & RIDDOR17/08/2023
Infection Control & Prevention22/08/2023
Health & Safety17/08/2023
Moving & Handling07/11/2023
Basic Life Support18/04/2024
Have you been appraised within the last 12 months?No
Vaccine History
Have you received the influenza vaccine?No
Would you consider having the influenza vaccine, if offered to you?Yes
Have you received both doses of either a Pfizer BioNTech or Oxford/AstraZeneca COVID vaccine?Yes
If Yes please attach your COVID vaccine passportCOVID.pdf
Employment HistoryCan you please provide details in the boxes below of your last 3 years employment (most recent first). If there are any gaps of 3 month or more it is important that you explain the reason why in the box below.
Employer name (1)Day Lewis Pharmacy
Position Held (Employer 1)Foundation Trainee Pharmacist
Location (Employer 1)South Norwood
Tel Number (Employer 1)02086532310
Date From (Employer 1)31/07/2023
Date To (Employer 1)26/07/2024
Employer name (2)Hartland Way Surgery
Position Held (Employer 2)Foundation Trainee Pharmacist
Location (Employer 2)Shirley
Tel Number (Employer 2)02087777215
Date From (Employer 2)06/11/2023
Date To (Employer 2)02/02/2024
Employer name (3)Sainsbury's Supermarket's
Position Held (Employer 3)Trading Assistant
Location (Employer 3)London Victoria
Tel Number (Employer 3)03300137247
Date From (Employer 3)24/09/2018
Date To (Employer 3)10/07/2023
Professional RefereesYou are required to supply at least two work related professional referees. The 2 referees provided must be within the last 12 months and be concurrent. If you have worked at the same Hospital for the last 12 months then we require 2 referees from that Hospital. Both referees must be a Consultant or Clinical Director. (We have allocated space for additional referees to be included, should you wish to provide more than two referees you must follow the above same principle.)
Name of First RefereeNina Bobie-Agyekum
Email of First RefereeEmail hidden; Javascript is required.
Address of First RefereeGoodwill Pharmacy
3 Trathen Square
London SE10 0BH
United Kingdom
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Phone of First Referee03337726162
Known Capacity of First RefereeSuperintendent Pharmacist
Name of Second RefereeMaxwell Lartey
Email of Second RefereeEmail hidden; Javascript is required.
Address of Second RefereeDay Lewis Pharmacy
3 High Street
London SE25 6EP
United Kingdom
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Phone of Second Referee07491130488
Known Capacity of Second RefereeDesignated Supervisor
Signature to apply for references
I give Total Assist Recruitment permission to forward my CV to agreed clients for the purpose of obtaining employment.
  • I agree
Equal Opportunities Policy

Equal Opportunities Policy

As an Equal Opportunities employer the organisation welcomes applications from suitably qualified persons from all sections of the community. The organisation is committed to achieving a working environment which provides equality of opportunity and freedom from discrimination on the grounds of race, nationality, religion, gender, class, family responsibilities, marital status, sexual orientation, age, disability or special need. The Directors believe in best practice in Equal Opportunities on the grounds of morality, good business practice and awareness that certain kinds of discrimination are unlawful. This is a key employment value to which all employees and candidates are expected to give their support. To ensure that the policy is effective it is essential that detailed monitoring is carried out, which necessitates the collection of information. The information on this form will be kept confidential and will not be used by those involved in the selection procedure and is for statistical purposes only and will not form part of any job application. *
Please SelectBlack
Criminal Record DeclarationNo
Have you ever had an Enhanced Disclosure Barring Service Check (previously DBS check) ?Yes
Disclosure Number001842871950
Date of Disclosure09/08/2023
Consent I agree
Applicants NameSarah Bonsu-Boateng
Applicant's Signature
For Office Purposes OnlyTHE F2F OFFICER MUST COMPLETE THE BELOW BEFORE LEAVING THE MEETING.