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Personal Details


Next of Kin Information (For Emergency Use Only)


Right To Work Details

Assign Dental Recruitment can only offer employment to Non-British citizens or Non-EU Nationals on receipt of proof of eligibility to live and work in the UK.

In line with Home Office guidance on the prevention of illegal working we will need to verify and take a copy of your original ID documentation as evidence of your right to work in the UK if you are to be engaged by Assign Dental Recruitment for temporary work.

If you have answered ‘‘No’ above, you must answer these questions:

Please supply details of any visa currently held:


Education & Training

Please complete as many education and training sections as needed

Education & Training 1

Education & Training 2

Education & Training 3

Education & Training 4


Professional Registrations

Please complete as many professional registration sections as needed

Professional Registration 1

Professional Registration 2

Professional Registration 3




Employment History

Please complete as many employment history sections as needed

Employment History 1

Employment History 2

Employment History 3

Employment History 4

Please provide in this section explanations for any gaps in your employment history (chronologically, most recent first). For any gaps in employment of 6 months or more over the past 5 years, please include contact details of your professional mentor or educational supervisor, who can verify the reason for the gap and if necessary provide you with an appropriate reference for the period not worked.


Referee Details

  • We require a minimum of 2 references.
    • References must cover a 3 year period of continuous employment, training or education. Your referees will need to confirm this. They may need to comment on your skills, personal qualities and suitability for the post.
    • Your referee could be an HR department, line manager or someone in a position of responsibility.
    • You must provide an email address for each referee. This may require you to contact your referee to confirm this prior to submitting your application, as this is a mandatory field.
    • If you are a student or trainee this should include a teacher/tutor at your school/college or university.
    • If you have not been in employment or education for the last 3 years, you may need to supply a character
      reference or a personal statement. A character reference must not be from a relative or someone who has a financial arrangement with you.
    • Emails for employers must be a valid work email address and not the referee’s personal email address unless the email being provided is covering a gap in work history or the employer no longer exists and the referee being used is a personal/character referee.
    • All reference requests will be verified by the recruiting employer.

Referee 1

Referee 2

Referee 3


Your Requirements


Bank Details


Tax Declaration


Personal Declaration And GDPR Consent


Compliance Documents

As per CQC requirements all candidates must provide the following documents:

Verification And Right To Work

Registration And Qualifications

Occupational Health And DBS

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