DepartmentTLA
Place of InterviewZOOM
Name of InterviewerWill Smith
Interviewer Email AddressEmail hidden; Javascript is required.
Date of Interview18/12/2023
Personal Details
Applicant NameAmineh Zarepour
Date of Birth08/05/1986
Marital StatusMarried
Do you hold a driving license valid for use within the UK?Yes
National Insurance NumberST929981B
Do you wish to register as a limited company?Yes
Company NameAvestan Healthcare Ltd
Company Nuimber14711530
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/BandBand 8
SpecialtyPharmacy
Next of Kin
NameDonaldas Urbonavicius
RelationshipSpouse
Contact Number+447472745647
Address41 BLACKBURN ROAD
41 BLACKBURN ROAD
WHITTLE-LE-WOODS CHORLEY, Lancashire PR6 8LF
United Kingdom
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Nationality
Do you hold a British Passport?No
Are you an EU Citizen?No
OtherIranian
Passport NumberHave no passport - Had protection Visa since Janyary 2019 and now applied for ILR
Passport Expiry Date03/01/2019
Should you hold any other Visa or residency permit, please provide the information below:

I have been on 5year protection visa from January 2019 till December 2023 and now awaiting the Home Office to decide on my
indefinite leave to remain permit. I have provided TLA with a copy of my BRP, Travel Document and also my ILR UAN for all
relevant checks with UKVI.

Current Address41 BLACKBURN ROAD
41 BLACKBURN ROAD
WHITTLE-LE-WOODS CHORLEY, Lancashire PR6 8LF
United Kingdom
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Mobile Phone+447472745647
Applicant Email AddressEmail hidden; Javascript is required.
Availability for Work
Availability to start work08/01/2024
Availability over the next 12 monthsOngoing
Which part of the UK do you prefer to work in?
  • North East
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 Number2221461
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?No
Have you received both doses of either a Pfizer BioNTech or Oxford/AstraZeneca COVID vaccine?No
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.
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.)
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 SelectOther
Criminal Record DeclarationNo
Have you ever had an Enhanced Disclosure Barring Service Check (previously DBS check) ?Yes
Consent I agree
Applicants NameAmineh Zarepour
Applicant's Signature
Interviewer's NameWill Smith
Interviewer's Signature
For Office Purposes OnlyTHE F2F OFFICER MUST COMPLETE THE BELOW BEFORE LEAVING THE MEETING.
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