New_Data Protection Consent Form (NOT INTEGRATED)

PLEASE NOTE: this form must only be completed by the MTI doctor/applicant. Any Data Protection Consent form submitted by anyone other than the doctor/applicant will be rejected by the Academy.

Name*

First NameLast Name

Please confirm you are the above-named individual and are authorised to complete this form*

I confirm

Current residential address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

The Academy of Medical Royal Colleges (the Academy) is committed to complying with the General Data Protection Regulation (GDPR) introduced in May 2018.

In accordance with this, we require explicit consent from doctors to store and process their personal information. Your information will not be used for marketing purposes and will only be shared with the relevant National Health Service (NHS) employer, NHS England, the General Medical Council (GMC) sponsoring organisation (usually a medical royal college), and the United Kingdom Visa and Immigration (UKVI) office. Your information will also be stored on Jotform, our online application provider.

Your data will only be used for the purpose of progressing your MTI application.

The data protection policy can be seen at www.aomrc.org.uk.

Please confirm you consent to your sensitive and personal data, such as your passport, biometric residence permit (if applicable), Home Office right to work profile (if applicable), residential and work address, MTI salary, and all other data collected during your MTI application process and placement, being held by the Academy*

I confirm

Please confirm you consent to this data being stored on Jotform and being shared between the Academy of Medical Royal Colleges, your National Health Service (NHS) employer, NHS England, your General Medical Council (GMC) sponsoring organisation (usually a medical royal college), and the United Kingdom Visa and Immigration (UKVI) office, and acknowledge this will only be done for the purpose of progressing your MTI application*

I confirm

Signature*

Date

Email address*

Confirmation Email

You have entered an AOMRC email address, which is not allowed. Please enter your own email address in the text box above.

Please confirm you authorise the Academy to email you at this address during your placement should we require further information from you*

I confirm