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Please submit the following Registration Information:

Surname

Forename

Address

Address

Town

County

Post Code

Country

Telephone No.

Mobile No.

Fax No.

Email

Marital Status

Nationality

Country Qualified

Have you worked in UK before?

Do you have a GMC Registration No.?

If Yes what is your GMC Registration no.

Do you have ALS Adult Resuscitation?

If yes what date did you pass it?

Do you have EPLS Paediatric Resuscitation?

If yes what date did you pass it?

Have you had a Hepatitis B test?

If yes what was the titre?

Have you had a Hepatitis C test?

Have you had a HIV test?

Any health concerns?

Available from (Start Date)

Available until (Finish Date)

Additional information




Alternatively, please send the following documents:

  • Minimum of two recent satisfactory clinical references (including telephone and fax numbers)
  • Current curriculum vitae GMC number (if and when registered)
  • Laboratory evidence of Hepatitis B immunity (in English)
  • Professional indemnity cover status, if held (e.g. MPS or MDU)
  • CPR qualifications (ALS/ACLS/ATLS and APLS/PALS) or equivalent


Please note that given the large number of candidates applying for posts, priority will be given to those doctors who provide full documentation. If you are unsure about the CVs, please see our download page where CV templates may be downloaded.

Postal Address: 30 Valley Drive, Wilnecote, Tamworth, Staffordshire, B77 5FP

t. +44 1827 254562
m. +44 7824 333030
30 Valley Drive, Wilnecote, Tamworth, Staffordshire, B77 5FP