APPLICANT NO.	MRP09/2024	

Position Applied For: 
FULL TIME OR PART TIME 
MEDICAL RECEPTIONIST
21hrs per week 

Closing Date: 
Friday 10th April 12 midday
Interviews week commencing 20th April 2026
	Please return to:
Recruitment Administrator
Killynether Practice
Regency Medical Centre
2A Frederick Street
Newtownards
BT23 4LR

Or email to: 
recruitment.Z00261@gp.hscni.net	

APPLICANTS PLEASE NOTE
•	Please complete in BLOCK CAPITALS and in BLACK INK or TYPESCRIPT. 
•	Each section of this form must be fully completed.  If the section has insufficient space, applicants should continue on the continuation sheet attached to the application form.
•	Applicants should particularly note the contents of the Personnel Specification and indicate in their form how they meet the criteria.  Only information contained in the application form will be considered at shortlisting.
•	CVs will not be considered.	

Surname:

	Mr/Mrs/Miss/Ms/Dr
Other (please specify)   	
Forename(s):

	Maiden Name
(if appropriate):	Other Name(s):	
Home Address:

Postcode: 	Address for Correspondence (if different):

Postcode:	
Home Telephone No.
(incl STD Code)  

E mail:   	Daytime Telephone No.
(incl STD Code)

Mobile No:         	
	National Insurance No.						
Nationality:  EC/Non-EC   

	If Non-EC, please specify	

EDUCATION - GENERAL

GCSE/‘O’ Levels/’A’ Levels/Other
Subjects passed	Date obtained	Examining Body	Level Attained	Grade Attained	

	

	

	

FURTHER EDUCATION
Degree/Diploma/Certificate/NVQ	Date Obtained	Awarding Body	Where obtained	Result obtained	

	

	

		

	

EXAMINATIONS PENDING
Qualification(s)	Date to be taken	

		

Please note that applicants will be required to produce evidence of those qualifications deemed as essential requirements of the post as detailed in the Personnel Specification prior to being appointed.

EMPLOYMENT HISTORY – PRESENT POST
Name and Address of present employer:
	Title and grade of post:

	Present Salary/Wage:
(please indicate whether weekly/ monthly/ per annum)
£ 	
Status:
Permanent/Temporary   
	Period of notice required:	
Department (if applicable):

	Date appointed:	Day
	Month
	Year
	
Present duties and Responsibilities:

	

PREVIOUS POSTS (Beginning with most recent)

NB:  To assist consideration of your application you are advised to give precise dates for each period of employment, where possible.  This is particularly important when there are time considerations for shortlisting criteria based on experience/post qualification experience.

Employer	
Grade/
Position
	
Please provide an outline of key duties, state level of wage/salary and reason for leaving
	Dates	
			From
D/M/Yr	To
D/M/Yr	

	

	
.	

Please account for any period since leaving school/third level education not covered by employment as stated previously

	
Please detail any other activities which may be relevant to your application (training/development courses attended etc)

	

Knowledge, Skills and Experience
Briefly explain how your knowledge, skills and experience meet the essential criteria outlined in the personnel specification. 

Knowledge

Skills

Experience

	

REFEREES
Please name two referees, (not relatives) both of whom should have knowledge of your present/ most recent work and be in a supervisory/managerial capacity. 

Do you give us permission to contact your referees at this stage   YES           NO (Circle as appropriate)

Name: 	Name:
	
Occupation:
	Occupation:
	
Address:

Postcode:	Address:

Postcode:	
Daytime Telephone No. 	Daytime Telephone No. 
	
Mobile No.	Mobile No.	
E mail address	E mail address	

Whilst the information given in this application is confidential, applicants are advised that legal processes may require the organisation to disclose the form to certain statutory bodies and, in some circumstances open Tribunal.

I confirm that the information provided on this application form is complete and correct and that any untrue or misleading information will give Killynether Practice the right to terminate any employment contract offered. 

I understand that the appointment is subject to 2 satisfactory pre-employment checks determined by the interview panel (including 2 two satisfactory references, satisfactory Access NI (Criminal Conviction check) and satisfactory Health Declaration check).  

I consent to the information I have provided in this form being used for: 
  1.  processing my application for this post, including both manual and computerised 
       records;

  2.  transfer to the employment record if I am appointed, including both computerised and 
       manual systems and will be held for up to 6 years thereafter and understand that this information will be processed in accordance with the Data Protection Act

I consent to the information being retained for a period of a minimum of 12 months, or longer in the event of any legal proceedings taken against the Surgery by any applicant in connection with this appointment.

Signature: ____________________________	Date:_____________________________

Continuation Sheet