Our Details

  • Address. Medical Locums Group, Challenge House, Sherwood Drive, Bletchley, Milton Keynes, MK3 6DP
  • Tel. 01908 048 999
  • Fax. 01908 483 989
  • Email. info@medical-locums.co.uk
  • Website. www.medical-locums.co.uk
  • Monday – Friday 08:30 – 22:00
  • Saturday – Sunday 10:00 – 16:00

Please complete all sections of the application form and return to the address provided. Please continue on separate sheets of paper, if necessary. The information provided on this form will be used as part of the selection process.

If you need assistance filling out this form, do not hesitate to call.

Out of hours emergency service available.

Please affix 2x standard Passport sized photo’s below:

Please make sure your passport is 600px x 600px in dimensions, has (jpg, jpeg, png, gif) as file extensions and no more than 1mb in file size.

1. Personal Details

Please complete this section using your full NMC registered name.

Mr.Mrs.Ms.Miss.
MaleFemaleOther
YesNo

2. Contact Details

3. Emergency Contact Details

4. References (please provide two references)

Reference 1:

Reference 2:

5. Appraisals