ࡱ> O <bjbj@@ 6"e"e* 8,0(" *0,0,0,0,0,0,0$25LP0P0e0G$G$G$R*0G$*0G$G$r-T.p(:m-0{000-5C 5."5.\0"G$:P0P09"05 :  APPOINTMENT FORM FOR CLINICAL ACADEMICS To: HR Division, Sussex House, Room 338, 鶹ý, Falmer, Brighton BN1 9RH. From: The Appointing Committee for BSMS Post Ref No:_________ recommends that an offer of appointment should be made as follows: Name (and Candidate Number): Job Title successful candidate will hold:  Start date: End date (if appointment fixed term): Department to be appointed to: Line-Manager (Academic):  Line-Manager (Clinical): If a replacement, who are they replacingContract type: If you are uncertain please contact your HR Business Partner to discussPlease indicate if this is:  FORMCHECKBOX  Education & Scholarship  FORMCHECKBOX  Education & Research  FORMCHECKBOX  Research only Primary Location: (Staff may have more than one location for their appointment, please only indicate primary) Period of Probation: Should you wish to offer a probationary period less than that detailed, or in waive this requirement for exceptional cases, please give reasons below: Please TICK applicable category  FORMCHECKBOX  Lecturer and Research Fellows - 3 years  FORMCHECKBOX  Senior Lecturer and Senior Research Fellows 5 years   Honorary NHS Contract required?   FORMCHECKBOX  YES Please state which NHS Trust contract to be held with: .NHS TRUST  FORMCHECKBOX  NO  Programmed Activities agreed as: Completed Integrated Job Plan attached:  Academic: . Clinical: .. Other:...(see below) Yes To Follow  Specify Salary Scale to be appointed to: (see University web page for details) . Basic Salary: . Threshold/Nodal Point .  Please detail below any further payments agreed (e.g. On-call allowance, APAs, Clinical Excellence award or any other payment and reasons.  DBS Disclosure required:  FORMTEXT YES  FORMCHECKBOX  /  FORMTEXT NO  FORMCHECKBOX  NHS Research Passport required:  FORMTEXT YES  FORMCHECKBOX  /  FORMTEXT NO  FORMCHECKBOX   Reserve candidate(s) name(s) and candidate number(s):    The membership of the Appointing Committee was: ---------------------------- ----------------------------- ---------------------------- ----------------------------- ---------------------------- ----------------------------- Details of other applicants are: Total no. of applicantsNo. on whom references calledNo. called to interview I confirm that BSMS would like to appoint the above candidate on the terms set out above Dean of BSMS signature :. Date: PLEASE RETURN THE FOLLOWING WITH THIS FORM: 1 SUCESSFUL APPLICANTS APPLICATION FORM 2 HEALTH QUESTIONNAIRE (SECTION A COMPLETED) 3 FULL INTERVIEW & SHORTLISTING NOTES/GRIDS FROM ALL PANEL MEMBERS 4 SALARY DETAILS OFFER LETTERS CANNOT BE ISSUED UNTIL ALL OF THE ABOVE ARE RECEIVED IF AVAILABLE PLEASE ALSO ATTACH: 5 COMPLETED INTERGRATED JOB PLAN 6 COMPLETED DBS PAPERWORK Interview Record for (post) :... (To be completed by Chairperson after interview) Date completed: .. Chairperson: Details of Candidate Recommended after Interview : No.NameBrief reasons for appointment based on person specification criteria:   Details of Candidates Rejected after Interview : No.NameBrief reason for non-appointment based on person specification criteria:           HEALTH QUESTIONNAIRE: (to be completed by the recruiting manager for new positions) Please indicate which of the following work risks / hazards apply to the post to enable Occupational Health to assess health screening requirements: This job involves:Work patternWork environmentRegular night workY/NAggressive/challenging behaviourY/NShift workY/NBlood/bodily fluidsY/NUnsocial hoursY/NChemicalsY/NContact with animalsY/NOccupational drivingDustY/NLight service vehicleY/NFreezer temperaturesY/NPSV/Minibus/LGV/HGVY/NFumesY/NGround maintenance equipment Y/NInvertebrate venoms (insect bites)Y/NCat D or equivalentY/NPests & diseases (plants, animal husbandry)Y/NCar userY/NPlant toxinsY/NFork lift truckY/NScabiesY/NTetanusY/NSpecial RequirementsNoiseY/NWork needing hearing protectionY/NTrafficY/NFood handlerY/NTuberculosisY/NColour visionVertebrate venoms (e.g. snake bite)Y/NGood long sight visionY/NVibration/Vibrating machineryY/NWorking alone (isolated)Y/NWeather/outdoors (inc sun exposure)Y/NWorking alone (contact with others)Y/NWorking on uneven groundY/NWorking with children/students/ vulnerable adultsY/NSewage/wasteY/NHealth care worker (Social Patient Contact)Y/NAsbestosY/NHealth care worker (exposure to bodily fluids)Y/NBiological agents hazard level 2Y/NUndertaking exposure prone procedures.Y/NPhysical demandsDisplay screen equipmentY/NPhysically activeY/NProlonged standingY/NRegular liftingY/NRegular bendingY/NSedentaryY/NWorking at heightsY/NWorking in confined spacesY/N     PAGE  PAGE 4 of 3 *+JT  µqfVJ>2h*uCJOJQJ^Jh 1CJOJQJ^JhoCJOJQJ^JhThrZg5CJOJQJ^JhrZg5OJQJ^Jh hrZgOJQJ\^Jh hTCJOJQJ\^JhT5CJOJQJ^JhrZgCJOJQJ^Jh5CJOJQJ^JhrZg5CJOJQJ^JhrZg5>*CJOJQJ^Jho5CJOJQJ^Jh`5CJOJQJ^J(jh~h~5CJOJQJU^J+,\ ] z { | } $$If]a$$]^a$gdT $]^a$ $]a$gd~$  ]^a$   ] z ~     ! $ % & ' @ C k l n 氤护{nbhBECJOJQJ^JhBE5CJOJQJ^JhBE5CJOJQJ^JaJh(5CJOJQJ^JhRi5CJOJQJ^Jh(CJOJQJ^JhrZg6CJOJQJ\]^JhrZg5CJOJQJ^Jh 1CJOJQJ^Jh 15CJOJQJ^JhrZgCJOJQJ^Jho>*CJOJQJ^J } ~ viYY$$If]a$gd( $$If]a$kd4$$IflFo &H)] 06    4 layt 1  $$If]a$skd4$$Ifl0oH)]+ 064 la  $$If]a$skd,5$$Ifl0oH)]+ 064 la    $$If]a$skd5$$Ifl0oH)]+ 064 la # $ % &  $$If]a$skd66$$Ifl0oH)]+ 064 la& ' @ A B wjw $$If]a$$$If]a$gd(xkd6$$Ifl0oH)]+ 064 layt(B C l m zm $$If]a$$$If]a$gd(ukdJ7$$Ifl0oH)]+ 064 lam n ~ 4 U yyeee\ $IfgdBE$d$If\$]a$gdBE$If]^gdBEukd7$$Ifl0oH)]+ 064 lan { ~     4 5 C D E S T ̺lVE h hBECJOJQJ^JaJ+jD9hBhBECJOJQJU^J+j8hBhBECJOJQJU^J+j\8hBhBECJOJQJU^J%jhBhBECJOJQJU^JhBhBECJOJQJ^J"h?yhe`56CJOJQJ^J"h?yhBE56CJOJQJ^JhBE5CJOJQJ^JaJ#hBhBE5CJOJQJ^JaJT U V i w x z ַ֖uhTuJuhhBECJOJQJ'j:hohBECJOJQJUhohBECJOJQJ!jhohBECJOJQJUhRihe`5CJOJQJ^Jhohe`CJOJQJ^J"h~he`6CJOJQJ]^Jhe`6CJOJQJ]^Jhe`6CJOJQJ\]^Jhe`5CJOJQJ^Jhe`CJOJQJ^J h he`CJOJQJ^JaJU V i }mmmmm$$If]a$gde`kd9$$Ifl0oH)]+ 064 lapyt ] x y z N V |||||||||o| $If]gde`$$If]a$gde`skdh:$$Ifl0oH)]+ 064 la   N W a b c UVdtgSDghohBECJOJQJ^J'j<hohBECJOJQJUhohBECJOJQJhBECJOJQJ^JhBEhBECJOJQJ^JhBE5CJOJQJ^Jhe`5CJOJQJ^Jhe`CJOJQJ^Jhe`CJOJQJ^Jhohe`CJOJQJ^JhBECJOJQJ!jhohBECJOJQJU'ja;hohBECJOJQJUV W X Y Z [ \ ] ^ _ ` a b |||||||||||$$If]a$gde`skd;$$Ifl0oH)]+ 064 la b c d 34yyiiii$$If]a$gde`  $IfgdBE $IfgdBE $If]gde`ckdZ<$$IflH)064 laytRi 4TULMf|skd=$$Ifl0oH)]+ 064 la$$If]a$gde` defhkMafghij xk\J\8\8\"hhe`5CJOJQJ\^J"hRihe`6CJOJQJ\^Jhe`5CJOJQJ\^Jhe`CJOJQJ\^Jhe`CJOJQJ^JaJ hRihe`CJOJQJ^JaJ#hRihe`5CJOJQJ^JaJhe`CJOJQJ^Jhe`CJOJQJ^Jhohe`CJOJQJ^JhBECJOJQJ!jhohBECJOJQJU'jK=hohBECJOJQJUfgh|$$If]a$gde`skdD>$$Ifl0oH)]+ 064 lahij|ooooo||||| $If]gde`$$If]a$gde`rkd>$$IflH)  064 lap ytpT %^_a~%ппппЮzl_UD_!jh@he`CJOJQJUhe`CJOJQJh@he`CJOJQJh|]&he`5CJOJQJhe`5CJOJQJh|he`5CJOJQJ^Jhe`5CJOJQJ^Jhe`CJOJQJ^J h_Khe`CJOJQJ^JaJ h(he`CJOJQJ^JaJhe`CJOJQJ^JaJhThe`CJOJQJ\^J"hhe`5CJOJQJ\^Jueeeeee$$If]a$gde`ykde?$$Ifl40oH)`]+ 064 layt|$p$If]pa$gde` qr/6|||ll$$If]a$gde` $Ifgde`ykd?$$Ifl4)0oH) ]+ 064 layt%&'*+-.<=>GHRSTVWYZhijrڻڻuڻaSFhe`5CJOJQJ\h|]&he`5CJOJQJ'jBh@he`OJQJUaJ'jAh@he`CJOJQJU'jAh@he`OJQJUaJh@he`OJQJaJ!jh@he`OJQJUaJh@he`CJOJQJ#h@he`CJOJQJmHnHu!jh@he`CJOJQJU'j@h@he`CJOJQJU   ,-./05᪝k᪝WMhe`OJQJaJ'jDh+=he`OJQJUaJ'jChhe`CJOJQJUhe`CJOJQJ'jCh+=he`OJQJUaJh+=he`OJQJaJ!jh+=he`OJQJUaJ#hhe`CJOJQJmHnHu'jBhhe`CJOJQJUhhe`CJOJQJ!jhhe`CJOJQJU6789 rkdE$$IflH)  064 lap ytpT $Ifgde`ckdD$$IflH)064 layt|]&5789:lqr@ADFGVipzm`m`Szmh 5CJOJQJ^Jh5CJOJQJ^Jh(*5CJOJQJ^Jh5CJOJQJ^JhrZgCJ OJQJ^JhrZg5CJOJQJ\^JhRi5CJOJQJ\^Jh ,hrZg5CJOJQJ^JhrZg5>*CJOJQJ^JhrZg5CJOJQJ^JhrZgCJOJQJ^Jhe`5CJOJQJhe`CJOJQJ^J9:rOykdE$$Ifl40r(`S50)64 laf4yt'&$$If]a$gdRi $$If]a$ ]^gd , $]^a$ 56ymYL?? 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