Personal Details: This should be six key facts in your personal details

o Date of Birth
o Nationality
o Address
o Email Address
o Telephone Number
o GMC Registration number
Education and Qualifications
Please give a list of all your medical qualifications
including any post-graduate degrees under taken.
Date
Qualification
University
Employment History
Please give a detailed description of your last 10 years of Locum Doctor and Per
manent Doctor Hospital work experience.
Date of Employment from - to
Position and Department
Name of Hospital
o Duties undertaken
Courses
List all Medical Courses attended
Key Skills/Strengths
List all your key clinical strengths and competences including any clinical skil
ls you may have.
Referees
List at least four of your most recent referees. Include telephone numbers, fax
numbers and email addresses.