WELCOME TO EVENT FIRE SOLUTIONS
AN INDEPENDENT FIRE
AND RESCUE SERVICE
0800 999 4343

Medical Recruitment Form

Please complete the form below if you would like to be considered for a medical staff position with Event Fire Solutions Ltd

[*all choices mandatory]

Titles:

Forename:

Middle Name:

Surname:

Have you ever changed your surname? (please select):

If yes please give details:

Are you a current employee of the NHS? (please select):

If yes which in which county do you serve? (please select):

Role applied for:

Please upload your CV here:

Home Tel:

Mobile Tel:

Current Address

Street Address:

City:

County:

Post Code:

If you have lived at the above address for less than 5 years, you must list each previous address (including postcode and date moved) in the box below. This also includes foreign addresses if you have lived/served overseas.

Previous Addresses

Street Address:

City:

County:

Postcode:

Street Address:

City:

County:

Postcode:

References

Reference 1

Name:

Address:

Postcode:

Referee's Job Title:

Relationship to you:

Reference 2

Name:

Address:

Postcode:

Referee's job title:

Relationship to you:

Certificates

Please upload any certificates you hold regarding your application to work with Event Fire Solutions (medical team)

Certificate 1:

Certificate 2:

Certificate 3:

Certificate 4:

If you have a recent photo then please upload it:

Other Data:

Other Details:

Do you suffer from any medical conditions?

Yes

If YES, please state details:

I hold a current Full UK drivers licence:

Yes

Tick all classes you hold:

Motor bike

Car

Car&trailer

7.5 tonne

LGV

HGV

Class 1

Have you ever been disqualified from driving?

Yes

If YES please provide a statement below:

Label:

Yes

If YES, please state details below:

I hold an EFAD/Blue Light driving certificate:

Yes

If YES, where did you receive this certificate from?

Do you have any adult / juvenile criminal convictions including police cautions / reprimands or cases pending? :

Yes

If YES, please state details below:

Do you hold a current CRB certificate?

Yes

All roles with Event Fire Solutions are on a self-employed basis, if you’re unhappy to proceed on that basis then we would like to thank you for your interest, but sadly we

would be unable to work with you any other basis.

I understand and accept that I will be fully responsible for all my own Tax and National Insurance contributions

Please confirm:

Yes