Society Of Our Lady Of Lourdes

Nurses Application

Application Form for Registered Nurses. Please be aware that you are accountable for arranging your own visa, obtaining your own Global Health Insurance Card (GHIC) and getting appropriate travel insurance if the GHIC is not adequate (if you have health concerns). You are responsible for making your own travel arrangements. We will arrange for our Tour Operator to send you a booking form in due course.

Title

First Name

Surname

Date of Birth

Address incl Postcode

Telephone Number

Are you a returning Nurse or Carer

Have you been to Lourdes before?

Please document your clinical experience and the relevant qualifications and dates

Where do you work now?

What is your current job title and responsibilities?

Are you confident to work with young and old, chronically sick pilgrims?

Please document any information here that you feel is pertinent to the above questions?

Are you registered disabled?

Do you have any physical / medical problems that might prevent you doing specific duties? If yes, please give brief details (please list your medications)

As a registered nurse part of your remit will be lifting and handling, you will also have to ensure the health and safety of others. Would you be able to do this?

What was your last update for lifting and handling?

When was the last update for infection control?

What is your Hepatitis B status?

What date was your last tetanus?

Do you speak any foreign languages, eg French?

State language and whether fluent (F), competent (C) or ‘enough to get by’ (GB)

Would you be willing to: Read at Mass?

Would you be willing to: Lead the Rosary?

How did you hear about the Society of Our Lady of Lourdes?

Please state your PIN number of your State Registration

Please give the date of your PIN of your State Registration

Please send a photocopy of your PIN and number to office@soll-lourdes.com

Please give any other information you think relevant to this application

Please provide your 12 digit DBS Reference Number (on the top right-hand side of your DBS Certificate)

I have read and agree to abide by the principles of the HELPERS POLICY (please confirm)

To complete your application, please provide the names and addresses of two referees; ideally these should be professional acquaintances.

The information you give us on this form will only be used by the Medical Team and is strictly confidential. Please choose how to contact you?

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Society Of Our Lady Of Lourdes

Society Of Our Lady Of Lourdes

Nurses Application

Nurses Application

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