Personal Details

Example Mr, Mrs, Dr, Miss, Ms

Emergency Contact

Right to Work Details

Professional Qualifications

Professional Registration

Appraisal & Revalidation

Professional Referee Details

Please provide a minimum of two clinical, professional referees. One must be from your present or most recent employer and both must be a senior grade to yourself who have supervised your work. References must cover at least 3 years of clinical employment. By signing this application form, you confirm that you are happy for Agency to contact your referees unless otherwise stated.

Rehabilitation of Offenders / DBS Checking

Due to the nature of the work for which you are applying, you are exempt from the provision of section 4(2) of the Rehabilitation of Offenders Act 1974. 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 to the positions in which the order applies. Failure to declare a conviction that later comes to light, may require us to exclude you from our register or terminate an assignment early.
If your DBS certificate is part of the annual update service, you will need to provide us with a full, clear copy of your Certificate before we can complete the check online. If you do not have a DBS certificate that is part of the annual update service, then we will need to complete a new check through Sirona. The Compliance team can advise you on how to do this. We strongly advise that once you receive your new certificate that you join the DBS update service for an annual cost of £13. This will stop the need for a new disclosure being made every year. We will be happy to provide more information regarding the DBS update service should you require it.

Staff Handbook

Please click link to review and submit Staff-Handbook

Once you've completed the Staff Handbook, please return to this page and tick to confirm. Upon registering with Sirona Medical you will have received a copy of our Staff Handbook which includes important information. You must read and familiarise yourself with the contents of our handbook, and in turn we will keep you updated with any changes.
I confirm that I have received, read and fully understood Sirona Medical staff Handbook and will adhere to its contents.

Working Time Regulations

The Working Time Regulations 1998 requires Agency to limit your average working week to 48 hours, unless you agree that this limit does not apply to you.

Professional Indemnity Cover


By signing below, you are confirming the following declarations:

Thank you for completing the Sirona Medical Candidate Application Form