Pharm-Assist - Register Page

Locum Online Registration

The information collected on this page is processed by a secure system; information collected is used in accordance with the Data Protection Act 1998.


I am a qualified:

RPSGB No.

RPSGB Registration Date:	(dd/mm/yyyy)

Personal Details

Title:
Forename:		Address 1:
Surname:		Address 2:
Email:		Address 3:
Telephone:		Town / City:
Mobile:		County:
Nationality:		Postcode:
Maritual Status:
Date of Birth:	(dd/mm/yyyy)
National Insurance No.

Qualifications

Please list your academic qualifications:-	Repeat Dispensing?
	Emergency Hormonal Contraception?
	MUR?
	Blood Pressure ?
	Home Away From Home?
	Coronary Heart Disease?
	Minor Ailments?
	Smoking Cessation?
	Other?
	Do you have indemnity insurance?
	Do you have a smart card?

Technician / Dispenser Qualifications

Are you an overseas qualified pharmacist?
NVQ Level 3 or Equivalent?
NVQ Level 2 or Equivalent?
Other? (Please state)
Are you currently working towards a qualification? (Please state)

Experience

Retail?		Computer Systems used:-
Hospital?		Nexphase?
Prison?		Compass?
Industry?		Pharmacy Manager?
		SmartScript?
		Other? (Please state)

Please state which companies you have worked for:

References


Company Name:		Company Name:
Address 1:		Address 1:
Address2:		Address2:
Town / City:		Town / City:
County:		County:
Postcode:		Postcode:

Job Requirements

Your hourly rate?	Weekdays:-	£'s per hour
	Saturdays / Sundays:-	£'s per hour

Do you require dispensing help?
Would you like to stay away?
Mode of transport?
Travel Radius	(miles)
Travel Rate (per mile)	(miles)
Any other requirement / preference?		Dates of Availability? Please provide us with dates you are available for work (Give as much information as possible)

Evidence

Prior to any placement offered, we need to confirm your identification and qualifications to the practice. Please forward all necessary documentation to PHARM-ASSIST.

Copies of ID and qualifications can be emailed to locums@pharm-assist.co.uk or posted to; PHARM-ASSIST, The Meadows Business Centre, 21 Bondgate, Selby, YO83LX.

CV:-
Passport / Work Permit :-
Qualification Certificates :-
Indemnity Insurance:-
2 Passport Sized Photographs:-

How did you hear about Pharm-Assist?

I have read and accept Pharm-Assist's terms and conditions published on this website

Thank you for taking your time to register with us. We look forward to working with you.