Dental Nurse Application Form

"*" indicates required fields

Step 1 of 6 – Personal Information

Personal Details

Marital Status*

Nationality*

Name*

Title First Name Surname

Date of Birth*

Day

Month

Year

Email*

National Insurance Number*

Mobile Number*

Home Tel

Home Address*

Street Address Address Line 2 Town/City County Post Code

Next of Kin (NOK)

Please provide details for who should be contacted in case of emergency.

NOK Name

NOK First Name NOK Surname

Relationship

NOK Mobile Number

NOK Email Address

NOK Home Address

Address Line 1 Address Line 2 (optional) Town County Post Code

Professional Details

Qualification(s) Held*

GDC Registration Number*

Has there been any proceedings of negligence or professional misconduct against you, and have you ever been suspended or dismissed from your employment?*

Yes

Briefly Supply Details*

Dental Practice Experience

Dental Anaesthesiology – Assisting with the administration and monitoring of anaesthesia in dental procedures.

Dental Implantology – Assisting in the placement and maintenance of dental implants.

Dental Public Health – Focus on preventing and controlling dental diseases through community-wide efforts.

Endodontics – Specialising in root canal treatment and diseases of the dental pulp.

Forensic Dentistry – Working in settings that require identification of individuals through dental records.

General Dental Practice – Assisting with all clinical aspects of dental care (e.g., fillings, root canals, crowns).

Geriatric Dentistry – Treatment of elderly patients.

Maxillofacial Unit – Assisting in a setting where the focus is on the face, jaw, and neck.

Mobile Dental Clinics – Providing dental care in non-traditional settings, such as schools, community centers, or remote areas.

Oral Surgery – Supporting in procedures such as extractions and oral surgeries.

Orthodontics – Assisting with the fitting of braces and other dental alignment procedures.

Paediatric Dentistry – Specialised care focused on children, from routine checks to specific treatments.

Periodontics – Assisting in the treatment of gum diseases and conditions.

Prosthodontics – Assisting in the creation and fitting of dental prosthetics (e.g., dentures, crowns).

Radiology – Experienced in taking and processing dental X-rays.

Sedation Clinic – Assisting with the management of patients undergoing dental treatments under sedation.

Special Care Dentistry – Working with patients who have special needs and require unique dental care approaches.

Travel & Work Preferences

Are you a Driver?*

Yes

Would you temporarily relocate for work (with accommodation)?

Yes

How many hours are you available to work each week?

Under 12 Hours

12 – 24 Hours

24 – 36 Hours

36+ Hours

How far are you willing to travel for work?

Enter Distance or Travel Time.

Please choose your preferred shift patterns

Days

Nights

Weekends

Flexible for any

Do you have a DBS Certificate that is registered on the Update Service?

Yes

Rehabilitation of Offenders Act

Because of the nature of the work for which you are applying, Section 4(2), and further Orders made by the Secretary of State under the provision of this section of the Rehabilitation of Offenders Act (1974) (Exceptions) Order 1975 applies. Applicants are therefore required to give information about convictions which for other purposes are “spent” under the provisions of the Act. Any information given will be completely confidential and will be considered only in relation for positions to which the order applies.

Have you at any time been convicted of an offense?*

Yes

If 'Yes', Briefly Supply Details*

Disclosure & Barring Service

DBS Consent 1*

I agree that Center Healthcare can access the DBS update service portal to check for any changes to my DBS clearances as and when necessary.*

DBS Consent 2*

I undertake to inform Center Healthcare should I be convicted of an offence in the future.*