Queen's Nurse Application Form 2025

Please read the guidance for applicants document before completing this form on the QNIS website- Guidance for Applicants - click here to access

We suggest that you work on a draft offline before entering your answers here as you cannot save and return. You can view the questions on the website.

If you have any queries before completing this form please contact Catriona at Catriona.mcclelland@qnis.org.uk

The closing date for applications is: noon, Wednesday 6th November 2024

Data protection statement:

Your privacy is important to us. Your data will be stored securely and will only be used in relation to the Queen’s Nurse Development Programme. It will not be shared with third parties for the purpose of marketing or other activity. The Queen's Nursing Institute Scotland will only use the information provided on this form if we wish to contact you to verify the information you have provided.

If your application is unsuccessful your data will be retained for no longer than six months, at which point it will be securely deleted. If your application is successful your data will be kept in accordance with GDPR.

For more information on your privacy rights please see our privacy policy https://www.qnis.org.uk/privacy-policy or contact comms@qnis.org.uk for a copy. Under the Data Protection Legislation, you have rights as an individual which you can exercise in relation to the information we hold about you. You can read more about these rights here – https://ico.org.uk/for-the-public/

1. Before you submit your application form we need your consent to hold your data in our system. *

Please tick the box to indicate that you consent.

2. Personal Details *

Surname	*
First name	*
Known as	*
Title (e.g. Mr/Mrs/Ms/Miss/Other)	*
NMC Registration Number	*
Revalidation date	*
Home address	*
Mobile telephone number	*
Home email address	*
How did you hear about the QN Programme?	*

3. Employment Details *

Current job title	*
Length of time in this role	*
Employer	*
Work address (full)	*
Work telephone number	*
Work email address	*

4. Nominating Nurse Executive Director (NHS staff) or equivalent executive leader within your organisation: *

Name	*
Email Address	*

5. Senior (Nurse) Manager acting as programme sponsor: *

Name	*
Email Address	*

6. PROFESSIONAL AND HIGHER EDUCATION (Undergraduate and post graduate of 1 year’s length or more) *

	Year	Institution	Qualification
1	1 Year	1 Institution	1 Qualification
2	2 Year	2 Institution	2 Qualification
3	3 Year	3 Institution	3 Qualification
4	4 Year	4 Institution	4 Qualification
5	5 Year	5 Institution	5 Qualification

7. KEY RESPONSIBILITIES IN CURRENT POSITION list briefly *

1	*
2	*
3	*
4	*
5	*

8. COMMUNITY NURSING EXPERIENCE List five things you have learned in any community nursing post you’ve held
Please state the job title and one thing you learned in that post (up to five posts) *

1	*
2	*
3	*
4	*
5	*