If yes, please state restrictions and the expiry date of any permissions: 2. EDUCATION & PROFESSIONAL QUALIFICATIONS PLACE OF STUDY SUBJECT / QUALIFICATION RESULT / GRADE DATE OBTAINED (mm/yyyy) NB: It is the Hospice's policy to verify the qualifications of all successful job applicants. 3. TRAINING COURSES ATTENDED (any relevant training, or work related skills (for example specialist or technical, I.T., languages, shorthand, etc.) TRAINING PROVIDER COURSE TITLE/ SUBJECT DURATION DATE COMPLETED (mm/yyyy) 4. REGISTRATION OR MEMBERSHIP OF GOVERNING / REGULATORY BODIES BODY (e.g. GMC, NMC, REGISTRATION TYPE/ REGISTRATION/ EXPIRY/ HCPC etc.) STATUS PIN NUMBER RENEWAL DATE Are you currently subject to any investigations or fitness to practise proceedings by a YES NO licensing or regulatory body in the or any other country? If YES, please provide details with your application Have you been removed from the register or have conditions been made on your registration by a fitness to practise committee or the licensing or regulatory body YES NO in the or in any country? If YES, please provide details with your application 5. OTHER MEMBERSHIP OF MEDICAL DEFENCE UNION/ PROFESSIONAL BODY OR ASSOCIATION MEMBERSHIP GRADE MEMBERSHIP DATE OF ENTRY MEDICAL DEFENCE NUMBER/ STATUS
If yes, please state restrictions and the expiry date of any permissions: 2. EDUCATION & PROFESSIONAL QUALIFICATIONS PLACE OF STUDY SUBJECT / QUALIFICATION RESULT / GRADE DATE OBTAINED (mm/yyyy) NB: It is the Hospice's policy to verify the qualifications of all successful job applicants. 3. TRAINING COURSES ATTENDED (any relevant training, or work related skills (for example specialist or technical, I.T., languages, shorthand, etc.) TRAINING PROVIDER COURSE TITLE/ SUBJECT DURATION DATE COMPLETED (mm/yyyy) 4. REGISTRATION OR MEMBERSHIP OF GOVERNING / REGULATORY BODIES BODY (e.g. GMC, NMC, HCPC etc.) REGISTRATION TYPE/ STATUS REGISTRATION/ PIN NUMBER EXPIRY/ RENEWAL DATE Are you currently subject to any investigations or fitness to practise proceedings by a licensing or regulatory body in the or any other country? YES NO If YES, please provide details with your application Have you been removed from the register or have conditions been made on your registration by a fitness to practise committee or the licensing or regulatory body in the or in any country? YES NO If YES, please provide details with your application 5. OTHER MEMBERSHIP OF MEDICAL DEFENCE UNION/ PROFESSIONAL BODY OR ASSOCIATION MEDICAL DEFENCE MEMBERSHIP GRADE MEMBERSHIP NUMBER/ STATUS DATE OF ENTRY