□ □ you received Vocational Training in General Practice? Yes No 17.Have yes, please provide scheme name: 18.If provide date of graduation from scheme: 19.Please of years in full-time General Practice: 20.Number (Or equivalent years in part-time) (Please specify) of years in current practice: 21.Number HOSPITAL EXPERIENCE provide a summary of hospital experience, including dates: 22.Please RESEARCH & TEACHING EXPERIENCE □Yes □No you undertaken any Research or Audit in General Practice? 23.Have yes, please provide details: 24.If provide details of any research undertaken and /or papers published, including dates: 25.Please list any teaching experience you may have:(Additional 26.Please qualifications can be added on page 9) OTHER AREAS OF RESPONSIBILITY professional responsibilities 27.Other (e.g., insurance, factory work etc):
17.Have you received Vocational Training in General Practice? □ Yes □ No 18.If yes, please provide scheme name: 19.Please provide date of graduation from scheme: 20.Number of years in full-time General Practice: (Or equivalent years in part-time) (Please specify) 21.Number of years in current practice: HOSPITAL EXPERIENCE 22.Please provide a summary of hospital experience, including dates: RESEARCH & TEACHING EXPERIENCE 23.Have you undertaken any Research or Audit in General Practice? □Yes □No 24.If yes, please provide details: 25.Please provide details of any research undertaken and /or papers published, including dates: 26.Please list any teaching experience you may have:(Additional qualifications can be added on page 9) OTHER AREAS OF RESPONSIBILITY 27.Other professional responsibilities (e.g., insurance, factory work etc):
tcd-hse---application-form.docx