4. PROFESSIONAL REGISTRATION (e.g. GMC, NMC, HPC for where there is a requirement to be registered with a governing body) REGISTRATION TYPE/ REGISTRATION/ EXPIRY/ GOVERNING BODY 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 other country? If YES, please provide details with your application 5. MEMBERSHIP OF MEDICAL DEFENCE / PROFESSIONAL BODY OR ASSOCIATION MEMBERSHIP MEMBERSHIP DATE OF ENTRY MEDICAL DEFENCE NUMBER/ STATUS OTHER PROFEESIONAL MEMBERSHIP GRADE MEMBERSHIP DATE OF ENTRY BODY/ASSOCIATION NUMBER/ STATUS 6. PRESENT OR MOST RECENT EMPLOYMENT EMPLOYER NAME & ADDRESS START DATE END DATE WEEKLY SALARY/ NOTICE JOB TITLE (mm/yyyy) (if applicable) HOURS GRADE PERIOD BRIEF DESCRIPTION OF YOUR DUTIES AND RESPONSIBILITIES REASON FOR LEAVING/ SEEKING CHANGE
4. PROFESSIONAL REGISTRATION (e.g. GMC, NMC, HPC for where there is a requirement to be registered with a governing body) GOVERNING BODY 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 other country? YES NO If YES, please provide details with your application 5. MEMBERSHIP OF MEDICAL DEFENCE / PROFESSIONAL BODY OR ASSOCIATION MEDICAL DEFENCE MEMBERSHIP MEMBERSHIP NUMBER/ STATUS DATE OF ENTRY OTHER PROFEESIONAL BODY/ASSOCIATION MEMBERSHIP GRADE MEMBERSHIP NUMBER/ STATUS DATE OF ENTRY 6. PRESENT OR MOST RECENT EMPLOYMENT EMPLOYER NAME & ADDRESS JOB TITLE START DATE (mm/yyyy) END DATE (if applicable) WEEKLY HOURS SALARY/ GRADE NOTICE PERIOD BRIEF DESCRIPTION OF YOUR DUTIES AND RESPONSIBILITIES REASON FOR LEAVING/ SEEKING CHANGE
Counselling-and-Bereavement-Support-Manager-Job-pack-MAR18.docx