National Performers Lists Application Form Page 22
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32Yes
No
(g) Have you ever been the subject of any investigation by any
regulatory or other body which included an adverse finding
(h) Are you currently the subject of any investigation by any
regulatory or other body
(i) Are you involved in an inquest as a person who falls within rule
20(2)(d) (entitlement to examine witnesses) or rule 24 (notice to
person whose conduct is likely to be called into question) of the
Coroners Rules 1984(c)
(j) Have you ever been the subject of any investigation by the NHS
Business Services Authority in relation to fraud which included an
adverse finding
(k) Are you currently the subject of any investigation by the NHS
Business Services Authority in relation to fraud
(l) Are you the subject of any investigation by the holder of any list
which might lead to your removal from the list
(m) Are you the subject of any investigation in respect of any current
or previous employment
(n) Have you ever been the subject of any investigation in respect of
any current or previous employment which included an adverse
finding
(o) Have you ever been removed or you are currently suspended
from, or have you been refused inclusion in or included subject to
conditions in, any list
(p) Are you, or have you ever been, subject to a national
disqualification
Name: (please print)
Signature:
Professional registration number:
Date: (DD/MM/YYYY)
NPL1 Application Form v2 final
Page 22 of 32
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