Visiting Professional Programme

Paediatric Pharmacy

2017/2018Application Form

Guy's and St Thomas' NHS Foundation Trust London, UK

How to Apply:

To be considered for the visiting professional programme, please complete the attached application form. Completed applications should be emailed to:

Guy’s and St Thomas’ Education & Events Team

Tel: + 44 (0) 207188 7188 ext 55865

If you would like to discuss any aspect of the visiting professional programme, including the different educational opportunities available, please contact the Education & Events Team at .

Once we have received your application, shortlisted candidates will be invited to attend a telephone interview to discuss the internship in more detail.

Candidates who are awarded a place on the visiting professional programme will be informed as soon as possible after their telephone interview.

Paediatric Pharmacy Visiting Professional Programme Application

1. Applicant details

Surname: ______

First Name:______

Work Address:

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Contact address:

(if different)

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Phone/Fax: ______

Email:______

2. Details of current role/ post

Post Held______

Name of Institution/ Employer Address:

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Phone/Fax:______

3. Supervisor/ Head of Department’s details

Surname: ______

First Name:______

Post held: ______

Work Address:

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Phone/Fax: ______

Email: ______

4. Please provide details of your Medical Degree and any other relevant qualifications you hold.

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5. Please outline your previous experience, relevant to this attachment (max 250 words).

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6. Personal Statement (maximum 500 words)

Please say how attending this Visiting Professional Programme will benefit you and why you wish to attend this Programme.

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7. CV Please attach a short CV: 2 sides of A4 (including any relevant publications)

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8.Programmes are offered for 6 weeks. Please state ideally the number of weeks you are hoping to come for.

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9. Start Date – when are you looking to start your programme?

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10. Area of Interest

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11.Please let us know how you heard about the Programme (please delete as necessary):

An Association (please specify which)

Advert Online (please specify where)

Public Health Website (please specify which)

Social Media (please specify where)

Hospital/medical centre communications (please specify which)

Other (please specify)

11. Signature Please kindly sign and date your application form

Signed:______

Date:______

Completed applications should be emailed to:

Guy’s and St Thomas’ Education & Events Team

Tel: + 44 (0) 207188 7188 ext 55865

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