Application form

Application Form

Examinations Subcommittee Part II Member with French Mother Tongue
Name*

First NameLast NameTitle
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Email*
example@example.com
Phone Number*

Area CodePhone Number
ESAIC Membership number*
6 digit
I have renewed my ESAIC membership for the current year*

I confirm
Curriculum Vitae written in English language and of maximum 3 pages*

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Picture *

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What are your motivation for applying for this position? *
Involvement in ESAIC activities? *
Current and past substantive positions, including in any ESAIC (sub)committee.
Experience in practising anaesthesia in a hospital with trainee anaesthetists *
.
Experience in teaching and education*
Examination related experience (ESAIC and non-ESAIC)*
Support from national authorities e.g. University, National Society, Ministry of Health, Ministry of Education *
Upload your recommendation letters*

if possible, one or more recommendation letters written in English issued and signed by the National Authorities supporting your application; these letters should be addressed to the Examinations Committee Chair (Prof. Dr Markus Klimek).
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Linguistic and translation skills *
Up to 5 relevant publications (with or without Personal Hirsch Index)*
Any other relevant information*
I have the necessary time available to commit to membership of an ESAIC subcommittee and appreciate that if I fail to provide the subcommittee with the required support, my three year tenure will not be renewed. I understand that my application may not be reviewed if I do not submit the required information before the application deadline*

I confirm
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