Pharmacy Job Application About YouYour Name First Last Your Address Street Address Address Line 2 City Postal Code Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Your Email Address Email Address Confirm Email Address Your PhonePosition applied forAre you legally eligible for employment in the UK? Yes No Do you require a work permit to work in the UK? Yes No Please note:Prior to making an offer of employment, we are required by law to verify documentary evidence (and maintain copies for files in compliance with GDPR) regarding a candidate’s eligibility to work in the UK. This applies to all applicants, regardless of nationality or origin. Current or most recent employment or work experiencePositionReason for leavingFull-time/Part-time?Name and address of employer:Nature of businessStart Date MM slash DD slash YYYY Notice period/end dateSalary/hourly rateSummary of duties/responsibilitiesPrevious Employment (most recent)1. Name and address of employer: OptionalStart Date Optional MM slash DD slash YYYY End Date Optional MM slash DD slash YYYY Position OptionalReason for leaving Optional2. Name and address of employer: OptionalStart Date Optional MM slash DD slash YYYY End Date Optional MM slash DD slash YYYY Position OptionalReason for leaving Optional3. Name and address of employer: OptionalStart Date Optional MM slash DD slash YYYY End Date Optional MM slash DD slash YYYY Position OptionalReason for leaving OptionalEducation & QualificationsUniversity name & address OptionalDate from Optional MM slash DD slash YYYY Date to Optional MM slash DD slash YYYY Level of education/results OptionalCollege/Higher Education name & address OptionalDate from Optional MM slash DD slash YYYY Date to Optional MM slash DD slash YYYY Level of education/results OptionalSchool name & address OptionalDate from Optional MM slash DD slash YYYY Date to Optional MM slash DD slash YYYY Personal interests/HobbiesPlease list some of your personal interests and hobbies below: OptionalReferencesPlease give the name, address and telephone number of two people who would be willing to give you a reference. If you are currently or have recently been employed, one of these should be your current or last employer. If not, a referee should be a person who can make a statement with regard to your character, e.g. a school or college teacher. Referees must not be members of your family or related to you in any way. 1. NameJob title (if applicable)AddressEmail PhoneHow does this person know you?2. NameJob title (if applicable)AddressEmail PhoneHow does this person know you?Information to support the application:Please upload any documents to support your application. This could be a covering letter and/or CV.File Drop files here or Select files Max. file size: 1 GB. If you are selected for an interview, are there any reasonable adjustments you would need us to make in order for you to attend? OptionalApplication declaration:I hereby give my consent, in connection with this application, for all previous employers, educational institutions, and references to be contacted to obtain and verify the accuracy of information provided by me in support of this application. I understand that any misrepresentation or material omission made by me on this application will be sufficient cause for cancellation of the application or immediate termination of employment, whenever it may be discovered. I understand that Eltham Medical Practice is permitted to hold personal information about me as identified on this application form as part of its recruitment procedures and personnel records. Note: Eltham Medical Practice is an equal opportunity employer and does not unlawfully discriminate in employment. No information provided by the applicant will be used to limit or exclude any applicant from consideration for employment on a basis prohibited by law Do you agree with the above statements? Yes Diversity monitoring informationOptional: You do not need to complete this if you do not wish to. This page will be removed from the application prior to assessment and is used only to monitor the recruitment process. I understand that any misrepresentation or material omission made by me on this application will be sufficient cause for cancellation of the application or immediate termination of employment, whenever it may be discovered. I understand that Eltham Medical Practice is permitted to hold personal information about me as identified on this application form as part of its recruitment procedures and personnel records. Note: Eltham Medical Practice is an equal opportunity employer and does not unlawfully discriminate in employment. No information provided by the applicant will be used to limit or exclude any applicant from consideration for employment on a basis prohibited by law Age range 18-24 Optional 24-34 Optional 35-44 Optional 45-54 Optional 55-64 Optional Please select the choice that best describes your cultural and ethnic origin White British Optional Black British Optional White Irish Optional Black Caribbean Optional Indian Optional Pakistani Optional White European Optional Black African Optional Bangladeshi Optional Other White origin Optional Other Black origin Optional Other Asian origin Optional Other Optional