Establishment of the R&D Office

HSC R&D Northern Ireland Clinical Research Network (NICRN) – Director

January2016

PLEASE COMPLETE IN TYPESCRIPT (Arial 11pt)
COMPLETED APPLICATIONS MUST BE SIGNED AND RETURNED BY
12.00pm Wednesday 23March 2016
1. / APPLICANT’S DETAILS
Name (inc. title)
Professional Background
2. / CURRENT EMPLOYMENT DETAILS
Present Job Title
Employing Organisation
Department
Address
Postcode
3. / CORRESPONDENCE DETAILS
Address
(if different from above)
Postcode
Telephone No. (Landline)
Telephone No. (Mobile)
E-mail
4. / Employment and Qualifications
Employment history and/or other appointments
Job / AppointmentTitle Organisation Dates
Relevant Qualifications
Dates
Professional Registration
Name of body Registration number Date of registration
5. /

Please detail your vision for clinical research in Northern Ireland and the NICRN in the next three to five years. (max 500 words)

6. /

Please describe the qualities you possess which demonstrate your commitment to clinical research in all HSC sectors and your ability to lead/negotiate across organisations, with the skills to hold others to account, and the personal commitment and interest to champion the NICRN. (max 500 words)

7. /

Please describe who you identify as the main stakeholders for NICRN activity and how you intend to work with them? (max 500 words)

8. /

Please give examples of how and when you have worked corporately and across organisational boundaries to achieve successful research outcomes which have implications for clinical practice. (max 500 words)

9. /

Please give details of your experience of conducting cross-national research and how would you anticipate fostering such work through the NICRN? (max 500 words)

10. /

Please give details of your track record of winning competitive national research funding and experience of conducting later-phase clinical trials and other well-designed studies as a Chief/Principal Investigator. (max 500 words)

11. /

Please describe how you intend to ensure involvement of patients and the public in the work of the NICRN. Please illustrate with any examples of innovative practice you have employed to date. (max 500 words)

12 /

Any other relevant information. (max 500 words)

13. /

NOMINATIONS FOR REFEREES

Please give details of two referees who may be contacted
Referee (1)
Name
Position
Institution
(if applicable)
Address
Postcode
Telephone / STD Code / No. / Ext
E-mail
Referee (2)
Name
Position
Institution
(if applicable)
Address
Postcode
Telephone / STD Code / No. / Ext
E-mail
14. /

DECLARATIONS

(i) / Applicant / “I declare that the information on this application form and any other information given in support of this application is correct to the best of my belief."
e-Signature / Date

PLEASE RETURN COMPLETED APPLICATION TO:

by 12.00pm Wednesday 23 March 2016

Miss Joanne O’Neill
HSC R&D Division,
4th Floor, Public Health Agency
12-22 Linenhall Street
BELFAST
BT2 8BS
Email:

HSC Research & Development Division, Public Health Agency