Trainees Committee Membership Application Form

Trainees Committee Membership Application Form
Please read the Trainees Committee member role and person specification before you complete this application form.
1. Your personal details
Your name*

TitleFirst NameLast Name (as registered with the GMC)
Main correspondence address*
Main telephone number*
Main email address*
example@example.com

3. Experience
Essential Attributes
Working effectively within a team
Please explain a) how you have worked effectively within a team and b) how you will apply those skills to the role of Trainees Committee member.*

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Commitment to the specialty
Please explain how you have demonstrated a commitment to the specialty of pharmaceutical medicine.*

0/250
Please upload a piece of evidence that demonstrates your commitment to the specialty.*

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Using initiative
Please explain how you have used your initiative.*

0/250
Please upload one piece of evidence that demonstrates your use of initiative.*

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Time and commitment
Please explain how you will devote the necessary time and effort to fulfil the requirements of a member of the Trainees Committee.*

0/250
Understanding and interest in developing education and training
Please explain your understanding of and interest in developing education and training activities in FPM.*

0/250
Desirable Attributes
Continuing professional development (CPD)
Please upload evidence of CPD - outside of PMST - that you have recently undertaken.

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Achievment and contributions to the specialty
Please upload evidence of any achievements in and/or contributions to the specialty.

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Membership of and contributions to a committee
Please upload evidence of successful membership of and positive contribution to a committee.

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Achievement relevant to the Trainees Committee
Please upload evidence in an activity or activities relevant to the work of the committee.

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Declaration
"I declare that I want to apply to become a member of FPM's Trainees Committee, and declare that the information given on this application form is true to the best of my knowlegde and belief. I give my permission to FPM to use my personal data for the purpose of committee administration."
UK data protection legislation requires organisations or agencies collecting personal data on individuals to gain their consent before collecting, storing, publishing or analysing their data. By completing and signing this application for membership of FPM you are giving your consent for your data to be stored and used by FPM. All data will be treated with the strictest confidence and will only be used for legitimate FPM purposes, see our privacy policy.
Applicant's signature*

Clear
Applicant's name*

First NameLast Name (as registered with the GMC)
Date*

DayMonthYear
Date
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