1. An application shall contain the following information:—
(a)(i)in the case of a dentist, the applicant’s full name, sex, date of birth and private address; telephone number and e-mail address and the applicant’s National Insurance number, if the applicant has one;
(ii)in the case of a body corporate the body corporate’s name, registered office and registered number, telephone number and e-mail address and a list of the full names, dates of birth, private addresses and (if they have one) the national insurance numbers, of all the directors and the company secretary;
(b)in the case of a dentist, the date of first registration and any subsequent registration as a dental practitioner in the register of dentists and registration number, dental qualifications registerable under the Dentists Act 1984 and when obtained;
(c)the address of the proposed Health Board premises where emergency dental services will be undertaken;
(d)(except where the applicant is a body corporate) chronological details of the applicant’s professional experience (including the starting and finishing dates of each appointment together with explanation of any gaps between appointments) with any additional supporting particulars, and an explanation of why the applicant was dismissed from any post;
(e)details of any list or equivalent list from which the applicant has ever been disqualified, conditionally disqualified, removed, suspended, contingently removed or suspended or to which admission was refused or conditionally granted together with reasons for such disqualification, conditional disqualification, removal, suspension or refusal;
(f)(except where the applicant is a body corporate) name and addresses of two referees who are willing to provide clinical references relating to two recent posts as a dentist each of which lasted at least 3 months without a significant break and which may include a current post, or, where this is not possible a full explanation and name and address of an alternative referee or referees;
(g)(except where the applicant is a body corporate) if the applicant is a national of an EEA state, evidence that the applicant has a knowledge of English which, in the interests of the applicant and of patients who may receive emergency dental services from the applicant, is necessary for providing general dental services;
(h)(except where the applicant is a body corporate) whether any limitations have been imposed by any government organisation which restrict the applicant’s ability to work in any specified capacity in Scotland and, if so, the details of these;
(i)if the applicant is, or has been where the outcome was adverse, the subject of any investigation by the Agency or any other body in relation to fraud.