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Rheoliadau Asiantaethau Nyrsys (Cymru) 2003
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Rheoliad 12(1)
ATODLEN 3YR WYBODAETH SY'N OFYNNOL MEWN PERTHYNAS Å NYRSYS SYDD I'W CYFLENWI GAN ASIANTAETH
1. Enw, cyfeiriad, dyddiad geni a Rhif ffôn.
2. Enw, cyfeiriad a Rhif ffôn y perthynas agosaf.
3. Prawf o bwy yw'r person, gan gynnwys ffotograff diweddar.
4. Naill ai —
(a)os yw'r swydd y mae'r nyrs yn cael ei chyflenwi i'w chyflawni yn dod o dan adran 115(3) neu (4) o Ddeddf yr Heddlu 1997, tystysgrif cofnod troseddol fanwl a ddyroddwyd o dan adran 115 o'r Ddeddf honno; neu
(b)mewn unrhyw achos arall, tystysgrif cofnod troseddol a ddyroddwyd o dan adran 113 o'r Ddeddf honno,
gan gynnwys, os yw'n gymwys, y materion a bennir yn adrannau 113(3A) a 115(6A) o'r Ddeddf honno a'r darpariaethau canlynol pan fyddant mewn grym, sef adran 113(3C)(a) a (b) ac adran 115(6B)(a) a (b) o'r Ddeddf hono.
5. Gwiriad heddlu, sef adroddiad a luniwyd gan neu ar ran prif swyddog heddlu o fewn ystyr “chief officer” yn Neddf yr Heddlu 1997 ac sy'n cofnodi, adeg llunio'r adroddiad, bob tramgwydd troseddol —
(a)y caniateir eu ddatgelu yn rhinwedd Gorchymyn Deddf Adsefydlu Tramgwyddwyr 1974 (Eithriadau) 1975(1); neu
(b)yr oedd y person wedi'i rybuddio amdanynt ac wedi'u cyfaddef adeg cael y rhybudd.
6. Dau dystlythyr oddi wrth nyrsys neu broffesiynolion iechyd eraill, gan gynnwys tystlythyr sy'n ymwneud â'r cyfnod cyflogaeth diwethaf fel nyrs nad oedd wedi para'n llai na thri mis.
7. Os yw'r nyrs wedi gweithio o'r blaen mewn swydd a oedd yn golygu gweithio gyda phlant neu oedolion hawdd eu niweidio, cadarnhad o'r rheswm pam y rhoes y gorau i weithio yn y swydd honno, ac eithrio os nad yw'r Cynulliad Cenedlaethol wedi penderfynu bod pob cam rhesymol wedi'i gymryd i sicrhau cadarnhad o'r fath ond nad yw ar gael.
8. Tystiolaeth bod y nyrs yn medru Saesneg i raddau boddhaol, os oedd cymwysterau nyrsio'r nyrs wedi'u sicrhau y tu allan i'r Deyrnas Unedig.
9. Tystiolaeth ddogfennol am unrhyw gymwysterau a hyfforddiant perthnasol.
10. Hanes cyflogaeth llawn, ynghyd ag esboniad ysgrifenedig boddhaol am unrhyw fylchau yn y gyflogaeth a manylion unrhyw gyflogaeth gyfredol ac eithrio at ddibenion yr asiantaeth.
11. Cofnod o statws imwneiddio.
12. Cadarnhad o'i chofrestriad cyfredol â'r Cyngor Nyrsio a Bydwreigiaeth, gan gynnwys manylion am y Rhan o'r gofrestr y mae'r nyrs wedi'i chofrestru ynddi.
13. Manylion unrhyw yswiriant indemnio proffesiynol.
(1)
O.S. 1975/1023. Mae diwygiadau perthnasol wedi'u gwneud gan O.S. 1986/1249, 1986/2268, 2001/1192 a 2002/441.
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