Northern Health Investigator Curriculum Vitae First & Surname: Present appointment (Job Title, Department) Address Full work address including postcode Qualifications PhD MBBS BN MSc BSc Degree and other professional Other: qualifications (relevant qualifications or Registration/licence number (if applicable) Previous appointments/experience (include only relevant therapeutic/ practical experience after gaining qualifications) Publications (Number of articles 0 0-5 6-10 11-20 >20 published) 1. List up to 3 most recent publications 2. 3. Previous experience in clinical trials Protocol design Trial procedures Consent Recruitment Data collection Data management Other – please describe below Research Relevant Training (accredited GCP year completed: Research Ethics: year completed courses) Other – please describe below List all HREC projects that you currently hold the role of investigator (Principal and/or Associate) Signature:_ _________________________________________ Date: ___/_____/_______
Northern Health Investigator Curriculum Vitae First & Surname: Present appointment (Job Title, Department) Address Full work address including postcode Qualifications Degree and other professional qualifications (relevant qualifications or PhD MBBS BN MSc BSc Other: Registration/licence number (if applicable) Previous appointments/experience (include only relevant therapeutic/ practical experience after gaining qualifications) Publications (Number of articles published) List up to 3 most recent publications 0 0-5 6-10 11-20 >20 1. 2. 3. Previous experience in clinical trials Protocol design Trial procedures Consent Recruitment Data collection Data management Other – please describe below Research Relevant Training (accredited courses) GCP year completed: Research Ethics: year completed Other – please describe below List all HREC projects that you currently hold the role of investigator (Principal and/or Associate) Signature:_ _________________________________________ Date: ___/_____/_______
5_NH-CV-Template-17Jul5.docx