Please continue on the following page if necessary Declaration The provision of false I certify that the information given on this form is correct to the best of information in an application form may my knowledge. I consent to the Nuffield Trust checking any information provided in this application and I agree to the information being used for be grounds for registration purposes under the Data Protection Act 1998. disqualification or, if appointed, dismissal. Signed: Date:
Please continue on the following page if necessary The provision of false information in an application form may be grounds for disqualification or, if appointed, dismissal. Declaration I certify that the information given on this form is correct to the best of my knowledge. I consent to the Nuffield Trust checking any information provided in this application and I agree to the information being used for registration purposes under the Data Protection Act 1998. Signed: Date: