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IA Application Form

The document is an application form for the role of International Advisor at the Royal College of Physicians and Surgeons of Glasgow, requiring personal, contact, and professional details. It includes sections for qualifications, motivations for applying, and connections to junior clinicians. Additionally, it outlines data protection information in compliance with GDPR regulations.

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asaad khan
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37 views2 pages

IA Application Form

The document is an application form for the role of International Advisor at the Royal College of Physicians and Surgeons of Glasgow, requiring personal, contact, and professional details. It includes sections for qualifications, motivations for applying, and connections to junior clinicians. Additionally, it outlines data protection information in compliance with GDPR regulations.

Uploaded by

asaad khan
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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International Advisor Application Form

SECTION 1 PERSONAL DETAILS


Title:
Family Name:
Forename(s):
PID:

SECTION 2 CONTACT DETAILS


Address:

Postcode/zip:
Country:
Telephone:
Mobile:
E-mail:
If you’re successful, we’ll display your contact details on our Networks page. If you’re happy to use the personal email address
included above, please tick this box:
If you wish to use a different personal email address, please enter it here:
If you don’t want to use your personal email, we will use our general inbox ([email protected]) and forward any
relevant emails to you.

SECTION 3 QUALIFICATIONS AND EMPLOYMENT


Primary qualification: Date awarded:
Additional qualifications and/or awards

Current job title: Workplace:


Length of time in post:

SECTION 4 Why do you want to be an International Advisor?


SECTION 5 What will you bring to the role of International Advisor?

SECTION 6 Please provide detail on any connections you have which would allow you to engage with junior clinicians in your
country during the early stages of their career, and potential methods of engagement.

SECTION 7 DECLARATION

I confirm that I hold no similar role in any other Royal College.

Signature: __________________________________________ Date ______________________

Please return the completed application form to:


Membership Engagement Team, Royal College of Physicians and Surgeons of Glasgow
232 - 242 St Vincent Street, Glasgow, G2 5RJ
Tel: +44 (0)141 221 6072 Fax: +44 (0)141 221 1804 e-mail: [email protected]
www.rcpsg.ac.uk
All Information concerning you as an individual will be held and processed by the College strictly in accordance with the provisions of the General Data Protection Regulation (GDPR)
(Regulation (EU) 2016/679). Such data will be used by the College to administer its relationship with you as a Fellow or Member. We will not, without your consent, supply your name
and address to any third party except where (1) such transfer is a necessary part of the activities that we undertake, including the provision of library services (if applicable) or (2) we are
required to do so by operation of law. As an individual you have a right under the General Data Protection Regulation (GDPR) (Regulation (EU) 2016/679) to obtain information from us,
including a description of the data that we hold on you. Should you have any enquiries about this right please email [email protected]

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