Expression of Interest Form

Thank you for expressing your interest in becoming an NHS Reserve in the Black Country.  We would like to arrange a call with you to discuss your interest, gather some additional details and inform you of what happens next. 

Please complete the following questions to provide some initial information and help us identify the best time for one of our team to call you.

By giving us your details, you consent to our privacy policy. Our privacy policy can be found at https://blackcountryics.org.uk/privacy. Please read it before filling out the form to check you are happy with the way your data will be used.

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What time of day is better to call you? (please select all that apply) Required
Are there any days of the week we should avoid contacting you on? Required
Are you a student? Required
Are you registered with a Professional Body? Required
Do you currently work in Health and Social Care Required
Do you currently work for any NHS or Care organisations in the West Midlands via an agency? Required
Which of the following roles are you willing to do as an NHS reserve? Required
Which environments are you happy working in? Required
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When are you able to start? Required
Privacy policy Required

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