Date | 22/11/2023 |
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Applicant Name | Funmilayo Abolanle Adelekan |
Date of Birth | 17/05/1964 |
Professional Registration Number | 5015357 |
I understand that any personal data held by The Locum Agency is liable to be inspected by the Care Standards Commission and/or any other authorised 3rd party including for any audits. Please select below if you do/do not agree for your personal data to be made available to any 3rd party without direct supervision from a member of staff from The Locum Agency or myself being present. | I agree |
I confirm that I give my permission to The Locum Agency to share my data with Total Assist Recruitment | I agree |
HTML Block | Next of Kin |
Next of Kin: Name | Son Opemipo Olisa |
Relationship | Son |
Address | 17 Middleton house Burbage close London, United Kingdom SE1 4EP United Kingdom Map It |
Do you hold a British Passport? | Yes |
Passport Number | 564149381 |
Passport Expiry Date | 18/11/2029 |
Are you an EU Citizen? | No |
Current Address | 17 Middleton house Burbage close London, United Kingdom SE1 4EP United Kingdom Map It |
Contact Number | +447828862978 |
Applicant Email Address | Email hidden; Javascript is required. |
HTML Block | 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 confirm that The Locum Agency have my permission to forward my CV and personal data (for e.g. occupational health details, DBS check) for vacancies that satisfy my requirements as stated above. I also give permission to check my DBS online service annually | I agree |
HTML Block | Equal Opportunities PolicyAs 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. |
Ethnicity | Black |
HTML Block | Criminal Record Declaration |
Under the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975, applicants for locum medical posts are not entitled to withhold information about convictions which for other purpose are ‘spent’. Therefore you are to inform The Locum Agency in writing of any convictions for criminal offences past in the future. | No |
Consent | ![]() |
Applicants Name | Funmilayo Adelekan |
Applicants Signature | |
Date | 22/11/2023 |