Paediatric Radiology Candidate Pack (080/56)

THE LONDON DEANERYin association with the East of England and Kent, Surrey & Sussex (KSS) Deaneries

Dear Applicant

Application to Specialty Training in Paediatric Radiology

Thank you for applying to a training programme in the London Deanery in association with the East of England and Kent, Surrey & Sussex (KSS) Deaneries. This letter explains the appointment process we use.

This pack contains:

a) A description of the training programme.

b) A person specification which describes the attributes for which we are looking. This is based around the GMC's document “Good Medical Practice”. Please note that you must be able to offer all of those attributes described as essential if you are to be considered for shortlisting and . or appointment.

c) An application form.

d) A shortlisting score sheet (for information only) which will show you how the shortlisting committee will judge your application against the requirements of the person specification.

Please read this pack carefully. As you fill out the application form you are advised to answer the questions and complete the form with reference to the person specification. Please note:

CVs and additional pages will not be accepted and therefore the application form should be fully and carefully completed.

When completing the applications form you must not make any adjustments to the spaces allowed for the responses.

The minimum type size which can be used is 10 point.

Failure to comply with the above instructions will result in your application being rejected.

Where equivalent qualifications or experience are being offered, it is essential that the candidate should provide confirmation of this from the relevant College or Faculty in the UK at interview.

The number of applicants called for interview will depend both on the number of the vacancies in the programme and on the shortlisting scores achieved by applicants during this recruitment.

The interview process will explore those areas included in the specification about which we need further information

Dr Fiona MossDirector of Medical and Dental Education Commissioning


Please email the completed application form to :

Jack Pegg, [email protected] Tel: 0207 866 3182, Fax: 0207 866 3276.

Reference number : 080/56

Closing date and time: 21st June 2010 at 12:00 midday (UK Local Time)

Interviews will be held on : 20th July 2010

Please let your referees know that you are applying for this post, so that if you are shortlisted, they will be prepared to respond to our reference request.

Successful applicants need to be aware that changes could occur during the progression of the training programme. The principal aim will always be to deliver the best quality training experience.

Applicants need to be aware that although trainees’ preferences are considered when making decisions on placements, final decisions take into account the service needs of all sites within our training programmes.

Thank you for applying to this training programme. Good luck with your application.

Yours sincerely

Jack Pegg

Medical Recruitment Administrator


mailto:[email protected]


*****Important information*****It is essential that all applicants read this page

Dear Applicant

Thank you for your interest in this training programme. The application form is enclosed.

It is essential that you give careful thought to your answers and complete each section accurately. Please note that you may be asked to provide evidence to support the statements you have made in any part of your form.

Please pay particular attention to the following and complete the corresponding sections in the application form as appropriate.

Visa status – International Medical Graduates

On 7 March 2006 the Home Office announced changes to the immigration rules which have an effect on Postgraduate Doctors and Dentists and which we must take into account during our recruitment activity.

From 7 March 2006 we have to recruit doctors and dentists from the UK and the EEA (including those doctors and dentists who have been accepted onto the Highly skilled Migrant Programme / Tier 1 who are not prohibited from taking employment as a Doctor in Training) before we recruit migrant doctors from outside EEA countries. However, if there are posts available on any of the London Deanery training programmes and no doctor or dentists with permanent residence or HSMP / Tier 1 (as described above) status in this country is able to take up the post, fully trained international medical graduates with the appropriate qualifications may also be considered for appointment. (Please see A Points-based System : Making Migration Work for Britain, pages 1 & 8).

The above statements represent our current understanding of the effects of the changes. For further information regarding the new immigration strategy please contact the Home Office’s Border Agency Enquiry Bureau on telephone 0870 606 7766 or by email: [email protected]

Fitness to Practise

When completing that part of the application form headed “Fitness to Practise and Criminal Investigations”, you should note that all doctors are exempt from the Rehabilitation of Offenders Act and you are therefore required to complete the section of the application form which related to your Fitness to Practise status.

If you have any queries about any of the statements in this section please do not hesitate to contact the Medical Workforce Department at the London Deanery as stated in the Fitness to Practise section. Any query you may have will be treated confidentially.

Criminal Records Bureau checks (CRB)

CRB checks are carried out by the employing Trust in accordance with the guidelines set out by NHS Employers (http://www.nhsemployers.org).

All offers of appointment are subject to CRB checks. The London Deanery will inform you first employing Trust of your offer of appointment, however on receiving your offer you should make contact with the Medical Staffing Department at your Trust to arrange for a CRB check

The London Deanery would like to wish you good luck with your application and your future career.

Updated 10th January 2010


http://www.nhsemployers.org/



*****Important information*****

THE LONDON DEANERY

General Statement of Policy

General Statement of Policy regarding fitness to practise proceedings by a licensing/regulatory body and relating to criminal records.

Registration with a professional body, such as the General Medical Council or General Dental Council, imposes a duty on health care professionals to provide a good standard of medical care for, and behave appropriately towards, patients. NHS employers also have a duty to ensure that patients receive a good standard of medical care and to take all practicable steps to ensure the safety of patients and staff.

In order to assess job related risks, the London Deanery needs to establish if applicants who may be offered a placement on a Specialty training programme have a criminal record in the UK or in another country that they can lawfully be required to disclose.

Applicants for Specialty training posts are exempted from the Rehabilitation of Offenders Act 1974, and can therefore be asked to disclose “spent” convictions that they would otherwise not have to declare.

Applicants for Specialty training posts will also be asked if they are “bound over”, have received a police caution, warning or reprimand and whether they have been charged with a criminal offence that is not yet disposed of.

Prior to making an appointment, the London Deanery also needs to establish if applicants for Specialty training posts have ever been disqualified from the practice of a profession or required to practise it subject to specified limitations following fitness to practise proceedings by a regulatory body in the UK or in another country, and whether they are currently the subject of any investigation or proceedings by any body having regulatory functions in relation to health/social care professionals, including such a regulatory body in another country.

Where such a position involves regular care, training, supervision or sole charge of persons aged under 18 or vulnerable adults (as defined by The Police Act 1997 (Enhanced Criminal Record Certificates)(Protection of Vulnerable Adults) Regulations 2000), applicants will also be asked whether they are currently the subject of any police investigation in the UK or any other country of which they are aware.

Where the position is a “regulated position” under the terms of the Protection of Children Act 1999 (as amended by the Criminal Justice and Court Services Act 2000), checks will be carried out in accordance with the Protection of Children Act 1999. Anyone whose name is on the list is legally barred from working with children. It is an offence for such a person to knowingly apply for, offer to do, accept or to do such work. If you are appointed to a Specialist Registrar post, you will be subject to a Criminal Records Bureau (CRB) check.

Applicants are encouraged to declare criminal conviction information and any other matters that are, or that might be, relevant to the position for which they are applying at an early stage in the appointment process.




All applicants are also expect to inform the London Deanery if, before taking up any position offered to them, they are charged with a criminal offence in the UK or another country.

The London Deanery is an equal opportunities recruiter, and all applications will be decided fairly and on merit. Information declared will be used to consider the applicant’s suitability for the position. Information supplied will be treated in confidence and will not be used as the sole criterion to decide an applicant’s fitness for the position.

Unless an appointment is prohibited by law, a criminal conviction will not automatically debar the applicant from appointment. Applicants will be given an opportunity to discuss any information supplied before a final decision is taken regarding their appointment.

However, an applicant may not be selected if the selection panel considers that the information declared renders that person unsuitable for the position for which they have applied. In reaching such a decision the London Deanery will consider the nature of the record/action, its relevance to the position applied for, and any other information the applicant wishes to provide.

The information declared will be treated in compliance with the Data Protection Act 1998.

NOTE: Failure by an applicant to provide accurate and truthful information is considered to be a serious matter.

Where it is found that a person has intentionally or recklessly provided inaccurate information or withheld information relevant to his/her position, this may disqualify them from an appointment, or if appointed, dismissal and referral to the appropriate professional regulatory body.

If you would like to discuss what effect any criminal record or fitness to practise proceedings might have on your application, you may telephone Jane Appleyard, telephone 0207 866 3105, in the Medical Workforce department, in confidence or email [email protected] .

Any information you provide regarding criminal investigations, convictions or fitness to practise proceedings will be kept confidential. If the Deanery considers that the information provided may have a bearing on your appointment and that the information needs to be considered by the selection panel, we will discuss this with you in advance. If we do not raise this information with you, this is because we do not believe that it should be taken into account. In that event, you still remain free, should you wish, to discuss the matter with the interviewing panel.

Prior to making a final decision concerning your application, we shall discuss with you any information declared by you that we believe has a bearing on your suitability for the position.

The London Deanery aims to promote equality of opportunity and is committed to treating all applicants for positions fairly and on merit regardless of race, gender, marital status, religion, disability, sexual orientation or age. We undertake not to discriminate unfairly against applicants on the basis of criminal conviction or other information declared.





The Data Protection Act 1998 requires us to provide you with certain information and to obtain your consent before processing sensitive data about you. Processing includes: obtaining, recording, holding, disclosing, destruction and retaining information. Sensitive personal data includes any of the following information: criminal offences, criminal convictions, criminal proceedings, disposal or sentence.

The information that you provide on the Declaration Form in the application form will be processed in accordance with the Data Protection Act 1998, and will only be used for the purpose of determining your application for this position. Once a decision has been made concerning your appointment, we will not retain this Declaration Form longer than is necessary (i.e. until you leave your post/programme or the recruitment episode is closed).

The Declaration Form will be kept in securely and in confidence, and access to it will be restricted to designated persons within the Medical Workforce Department of the London Deanery and other persons who need to see it as part of the selection process and who are authorised to do so. The information may be passed to your employing trusts.


Candidate Number : ____________________________

To applicants: you should complete your application form after carefully reading this person specification which is based on the GMC’s “Good Medical Practice”

THE LONDON DEANERYin association with the East of England and Kent, Surrey & Sussex (KSS)

Deaneries

SPECIALTY TRAINING IN PAEDIATRIC RADIOLOGY

PERSON SPECIFICATION

ESSENTIAL WHEN EVALUATED

DESIRABLE WHEN EVALUATED

QUALIFICIATIONS Eligible for registration with the GMC

MBBS (or equivalent)

FRCR by date of shortlisting panel

OR

Eligible to be registered as a Specialist with the GMC

AF

AF

AF

AF

BSc (or other intercalated degree), other degrees / qualifications

MRCP, MRCS or equivalent

Research MD, PhD

AF

AF

AF

CLINICAL EXPERIENCE At least 4 years Radiology experience

Resuscitation training in last 3 years of clinical experience eg ALS etc

AF

AF

Broad clinical experience

AF

CLINICAL SKILLS Experience of and competent at practical procedures

experience of clinical risk management

Competent to work without direct supervision where appropriate

Clear, logical thinking showing an analytical / scientific approach

AF, I/V, Ref

AF, I/V

I/V, Ref

AF, I/V

KNOWLEDGE Appropriate level of clinical knowledge

Shows knowledge of evidence informed practice

Shows awareness of own limitations

Ref

I/V

I/V, Ref

Demonstrates breadth of experience and awareness in and outside specialty / medicine

Demonstrates use of evidence informed practice

AF, I/V

I/V


ORGANISATION AND PLANNING

Ability to prioritise clinical need

Ability to organise oneself and own work

Completed audit project in last 2 clinical years

Experience and ability to work in multi-professional teams

I/V, Ref

I/V, Ref

AF

AF, I/V, Ref

Understanding of NHS, clinical governance & resource constraints; management / financial awareness; experience of committee work

Active involvement in audit

Information technology skills

Leadership / administrative responsibilities

AF, I/V

AF, I/V

AF

AF

TEACHING SKILLS Evidence of teaching experience; enthusiasm for teaching; exposure to different groups / teaching methods

AF, I/V

ACADEMIC / RESEARCH

Research experience

Presentations, publications, prizes and honours

I/V

AF, I/V

CAREER PROGRESSION

Progression of career consistent with personal circumstances

Demonstrates a commitment to and knowledge of the specialty

AF

AF, I/V

START DATE Available to start on post on 1st May 2010

AF, I/V

PERSONAL SKILLS COMMUNICATION & LANGUAGE SKILLS (the ability to communicate with clarity and intelligibility in written and spoken English; ability to build rapport, listen, persuade, negotiate)

AF, I/V, Ref

DECISIVENESS/ ACCOUNTABILITY (ability to take responsibility, show leadership, make decisions, exert appropriate authority)

I/V, Ref


INTERPERSONAL SKILLS (see patients as people, empathise, work co-operatively with others, open and non-defensive, sense of humour)

AF, I/V, Ref

USES A NON-JUDGMENTAL APPROACH TO PATIENTS AND COLLEAGUES regardless of their sexuality, ethnicity, disability, religious beliefs or financial status

Ref

FLEXIBILITY (able to change and adapt, respond to rapidly changing circumstances)

I/V, Ref

RESILIENCE (able to operate under pressure, cope with setbacks, self-aware)

I/V, Ref

THOROUGHNESS (is well prepared, shows self-discipline/commitment, is punctual and meets deadlines)

I/V, Ref

SHOWS INITIATIVE/ DRIVE/ENTHUSIASM (self-starter, motivated, shows curiosity, initiative)

AF, I/V, Ref

PROBITY (displays honesty, integrity, aware of ethical dilemmas, respects confidentiality)

I/V, Ref

PHYSICAL REQUIREMENTS

Meets professional health requirements

pre-employment health screening


Please complete this application form carefully. CVs and additional pages will not be accepted.


Deaneries

APPLICATION FORM

SPECIALTY TRAINING PROGRAMME IN PAEDIATRIC RADIOLOGY (080/56)

PART ONE

Section A – Personal Details

Surname : Forenames :

Title : If previously known by another name, please specify :

Home Address : Address for correspondence :

Home telephone number :

Home Fax number :

Email address :

Mobile phone number :

Work telephone number :

Work fax number :

Date available to start if offered the post

Section B – General Medical Council Registration

Do you have, or are you eligible for, FULL GMC registration?

GMC Number Renewal date Name in which you are registered

If not registered with the GMC at time of application, will you be eligible for FULL registration by the time of appointment? Please give details below.


Section C – Equal Opportunities Monitoring Form

We are committed to eliminating unlawful discrimination from employment and selection practices. We will take steps to ensure that employees are recruited, trained and promoted on the basis of ability, the requirements of the job and the need to maintain an efficient and effective service. To monitor this policy, we require the following information which will only be used for this purpose. It will form no part of the interviewing process, and will be treated in strict confidence. This sheet will be detached from your application form on receipt. If you are appointed, it will be kept on your training record, otherwise it will be destroyed 6 months after the appointments committee.

IF YOU DO NOT COMPLETE THIS SECTION OF THE APPLICATION FORM, YOUR APPLICATION WILL NOT BE CONSIDERED COMPLETE AND WILL NOT BE PUT FORWARD FOR SHORTLISTING

DATE OF BIRTH: AGE:

GENDER: please select

Male Female

Transgender Male Transgender Female

I do not wish to disclose my gender

Race Relations (Amendment) Act 2000

I would describe my ethnic origin as: (please select)

Asian or Asian British Mixed Other Ethnic Group

Bangladeshi White & Asian Chinese

Indian White & Black African Any other ethnic group

Pakistani White & Black Caribbean Please specify below:

Any other Asian background Any other mixed background

Black or Black British White Undisclosed

African British I do not want to disclose my

Caribbean Irish Ethnic origin

Any other Black background Any other white background

Employment Equality Regulations 2003

Please select the option which best describes your sexuality

Lesbian / Gay woman Heterosexual

Gay Man I do not wish to disclose my sexual orientation

Bisexual

Please indicate your religious belief

Atheism Jainism Judaism

Buddhism Sikhism Hinduism

Christianity Other

Islam I do not wish to disclose by religion / belief


Disability Discrimination Act 1995

The Disability Discrimination Act protects disabled people. This includes people with long-term health conditions. If you tell us that you have a disability we can make reasonable adjustments to where you work and your work arrangements or at interview.

Do you consider yourself to have a disability? Yes I do not wish to disclose this information

No

Please state the type of impairment which applies to you. People may experience more than one type of impairment, in which case you may indicate more than one. If none of the categories apply, please mark “other”.

Physical impairment Learning Disability / Difficulty Mental Health Condition

Sensory impairment Long-standing illness Other

If you have a disability, do you require any specific arrangements to enable you to attend for interview? ---Please Select---

If YES, (I have a disability which I consider relevant to my application) please describe any adaptation or adjustment you consider an employer should make to accommodate you if you are shortlisted for interview / appointed on a separate piece of paper and place in a sealed envelope addressed to Jane Appleyard, Medical Workforce, London Deanery, Stewart House, 32 Russell Square, London WC1B 5DN. Please mark the envelope “CONFIDENTIAL”. Alternatively, you may send an email to [email protected] , Please also let us know if you need any special arrangements to enable you to attend for interview.

If you have a disability, provided you meet the minimum criteria as specified in the Person Specification, do you wish to be considered under the Guaranteed Interview Scheme? Pleas see the Disability Discrimination Act for more details

If you tick Yes you must email [email protected] to ensure your eligible for the guaranteed interview scheme. Failure to do so may result in you not being granted a guaranteed interview. Emails to this address are managed in strict confidence and will not be shared with the interview panel. Please see the Disability Discrimination Act for more details.

---Please Select---

Do you wish to apply for a deferred start date because you are registered for a higher degree (eg PhD, MD)?

---Please Select---

Date available to start post – please give reasons

Do you wish to be considered for less than full-time training?

If you select “Yes” as you wish to be considered for less than full-time training, this information will not be made known to the selection panel but you will need to formally apply for less than full-time training via the deanery Flexible Training Team. Further guidance and details on how to apply can be found on the deanery website

---Please Select---




D: Language Skills You are required to demonstrate skills in written and spoken English that are adequate to enable effective communication about medical and/or health topics with patients, colleagues and the public.

Evidence of English language proficiency – If you select ‘No’ to both boxes then you must complete the ‘Other’ Section.

Country of Primary Medical Qualification (See list within Appendix A)

Was your undergraduate training taught in English? ---Please Select---

Have your language skills been tested through the IELTS (International English Language Testing System) to the minimum overall score required as per the person specification1?

---Please Select---

Overall Score

Speaking Score

Listening Score

Reading Score

Writing Score

Date IELTS taken (dd/mm/yyyy)

Have all components of the IELTS been completed in one sitting? ---Please Select---

Other – Please provide details below – provide evidence of your English Language proficiency (max 50 words)

Where did you see this post advertised?

BMJ London Deanery website

NHS Jobs

1 The Applicant must have achieved as a minimum the following scores in the academic International English Language Testing System (IELTS) in a single sitting within 24 months at time of application – Overall 7, Speaking 7, Listening 7, Reading 7, Writing 7


E: Right To Work in the United Kingdom Some applicants may be considered before others on the basis of immigration status, in accordance with guidance from the UK Border Agency. If you require Tier 2 sponsorship in order to take up the offer of a place on this training programme and you are subject to the Resident Labour Market Test, your application will not be considered in this round of recruitment. Applicants in this category should consider re-applying to any further rounds of recruitment in this speciality.

1a Are you a United Kingdom (UK) national ---Please Select---

1b Are you a European Community (EC) or European Economic Area (EEA) national?2 ---Please Select---

1c Are you a Bulgarian or Romanian national

*Please complete the immigration status applicable---Please Select---

2 If not, do you have evidence of entitlement to enter and work permanently in the United Kingdom without restriction i.e Indefinite Leave to remain – free from immigration control?

---Please Select---

If you have selected no to both of the above please mark with a cross the boxes below in the Personal Status section which define your immigration status and complete start and expiry date of your permit, unless you also tick yes to the question below, in which case you need to go to the Partner/Civil Partner/Spouse Status section.

3 Are you on a dependents visa*

*If you have answered YES please complete the Partner/Civil Partner/Spouse status section

---Please Select---

Nationality (Choose country pertaining to your nationality - see country list – Appendix A)

Personal Status

Select Status Start Date Expiry Date

Bulgarian or Romanian National with Blue registration certificate

Highly Skilled Migrant Programme (dates of endorsement stamp in passport)

Points based system – with endorsement “no employment as a doctor in training”

Points based system – no endorsement regarding “employment as a doctor in training”

Permit Free Training / Postgraduate doctor or dentist

Refugee in the UK

Work Permit / Tier 2

Tier 4 – UK Graduate

Tier 4 – Not a UK Graduate

Tier 4 – Studying for a Masters/PHD

UK ancestry

Student visa holder

Other immigration categories i.e. Overseas government employees, Innovators etc.

2 For the purposes of this form Switzerland has been included within the EEA national category


If Other than above – Please specify the immigration category (Max 50 words – 455 Characters)

Partner / civil partner / spouse status

Please complete this section if you have answered YES to question 3 above.

Select Status Start Date Expiry Date

Partner / civil partner or spouse of UK / EEA3 citizen

Non EEA national partner / civil partner or spouse of EEA4 citizen exercising a treaty right

Partner / civil partner or spouse of HSMP holder

Partner / civil partner or spouse under the Points based system – with endorsement “no employment as a doctor in training”

Partner / civil partner or spouse under the Points based system – no endorsement regarding “employment as a doctor in training”

Partner / civil partner or spouse of student visa holder – student visa holder must have 12 months or more leave to remain

Partner / civil partner or spouse of other immigration categories i.e. refugees, work permit holders, Overseas government employees, Innovators etc.

If Other than above – Please specify the immigration category (Max 50 words – 455 Characters)

If you are shortlisted, you will be required to produce the original documents (passports, page with the stamp and letter from the Home Office) on the interview day.

3 For the purposes of this form Switzerland has been included within the EEA national category


F: Fitness to Practise and Criminal Investigations We aim to promote equality of opportunity and are committed to treating all applicants for positions fairly and on merit regardless of race, gender, marital status, religion, disability, sexual orientation or age. We undertake not to discriminate unfairly against applicants on the basis of criminal conviction or other information declared.

Prior to making a final decision concerning your application, we shall discuss with you any information declared by you that we believe may have a bearing on your suitability for the position. If we do not raise this information with you, this is because we do not believe that it should be taken into account. In that event, you still remain free, should you wish to discuss the matter with the interviewing panel. As part of assessing your application, we will only take into account relevant criminal record and other information declared. However, please be advised that any failure to declare relevant information relating to your fitness to practice may well lead to your application being withdrawn, and/or any employment or training programme placement terminated.

The Data Protection Act 1998 requires us to provide you with certain information and to obtain your consent before processing sensitive data about you. Processing includes: obtaining, recording, holding, disclosing, destruction and retaining information. Sensitive personal data includes but is not limited to any of the following information: criminal offences, criminal convictions, criminal proceedings, disposal or sentence.

The information that you provide in this Declaration Form will be processed in accordance with the Data Protection Act 1998. It will be used for the purpose of determining your application for this position. It will also be used for purposes of enquiries in relation to the prevention and detection of fraud. Once a decision has been made concerning your appointment, we will not retain this Declaration Form longer than is necessary (ie until you leave the post you are applying for / programme or the recruitment episode is closed).

This Declaration Form and any information provided relating to a positive declaration will be kept securely and in confidence, and access to it will be restricted to designated persons within the Recruitment Department and other persons who need to see it as part of the selection process and who are authorized to do so. If successfully appointed to a training post, this information may be passed to your employing trusts.

Rehabilitation of Offenders Act 1974

Before you can be considered for appointment in a position of trust as a Specialty Trainee on a Deanery programme, we need to be satisfied about your character and suitability.

This post is considered a “regulated activity” within the terms of the Safeguarding Vulnerable Groups Act 2006, and appointments made after 26 July 2010 will be subject to registration with the Independent Safeguarding Authority (ISA). This will become a mandated requirement from 1st November 2010. Only successfully registered employees will be permitted to continue their training and employment after that date.

It is vitally important that you read, understand and answer the questions asked in this section by selecting each box – please read the accompanying notes carefully before completing this part of the form.

Please answer all of the following questions. If you answer “YES” to any of the questions, please ensure you provide full details via email to [email protected] by the closing date if application. Failure to do so may result in your application being withdrawn. In this email please indicate clearly the programme for which you are applying, the question(s) to which you have provided a positive response.

The position for which you have applied is exempted from the Rehabilitation of Offenders Act 1974. This means that you must declare all criminal convictions, including those that would otherwise be considered “spent”. Answering “YES” to any of the questions below will not necessarily bar you from appointment. This will depend on the nature of the position for which you are applying and the particular circumstances.



If you would like to discuss what effect any previous convictions, police investigations or fitness to practice proceedings taken or being taken either in the UK or by an overseas licensing or regulatory body might have on your application, you may telephone: Jane Appleyard at the Deanery on 020 7 866 3105 in confidence.

1 Are you currently bound over or have you ever been convicted of any offence by a Court or Court-Martial in the United Kingdom or in any other country? NB You do not need to tell us about parking offences.

---Please Select---

2 Have you ever received a police caution, reprimand or final warning? ---Please Select---

3 Have you been charged with any offence in the United Kingdom or in any other country that has not yet been disposed of?

Please note: you must inform us immediately if you are charged with any offence in the United Kingdom or in any other country after you complete this form and before taking up any position offered to you. You do not need to tell us if you are charged with a parking offence.

---Please Select---

4 Are you aware of any current police investigation in the United Kingdom or in any other country following allegations made against you?

---Please Select---

5 Are you aware of any current NHS Counter Fraud and Security Management Service investigation following allegations made against you?

---Please Select---

6 Have you ever been investigated by the Police, CFSMS or any other Investigatory Body resulting in a caution, conviction or dismissal from your employment? (Investigatory bodies include Local Authorities, Customs & Excise, Immigration, Passport Agency, Inland Revenue, Department of Trade & Industry, Banks and Building Societies, General Life Insurance Companies – this list is not exhaustive, and you must declare any investigation conducted by an Investigatory Body).

---Please Select---

7 Have you ever been dismissed by reason of misconduct from any employment, office or other position previously held by you?

---Please Select---

8 Have you ever been disqualified from the practice of a profession or required to practice subject to specified limitations / conditions / warnings following fitness to practice proceedings by a regulatory or licensing body in the United Kingdom or in any other country?

---Please Select---

9 Are you currently the subject of any investigation or fitness to practice proceeding by any employer, any licensing or regulatory body in the United Kingdom or any other country?

---Please Select---

10 Are you subject to any other prohibition, limitation, or restriction that means we are unable to consider you for the position for which you are applying?

---Please Select---

If you have answered “YES” to any of the questions, please provide full details on a separate sheet and place in a sealed envelope addressed to Jane Appleyard, Medical Workforce, London Deanery, Stewart House, 32 Russell Square, London, WC1B 5DN. Alternatively, you can email the details to [email protected] . Please indicate clearly the number(s) of the question (s) that you are answering. Please mark the envelope “CONFIDENTIAL”

You are reminded that if you are appointed to a training post or programme, you will have a continuing responsibility to inform your employer(s) and the Postgraduate Dean of any new criminal convictions, police

investigations or fitness to practice proceedings that arise in the future.

Note: if you wish to withdraw your consent at any time after completing this Declaration Form, please contact Jane Appleyard at the Deanery (see above).



Section G – Referees Reference reports are not used for scoring purposes during shortlisting or interview, but will be reviewed during the selection process and again prior to confirmation of appointment for successful applicants. The reference process is designed to check the accuracy of your previous employment and training history and to provide assurance of your qualifications, integrity and track record.

You must provide contact details, including email addresses of three referees who have supervised your clinical training during the last three years of your employment or undergraduate training. One referee must be your current or most recent Consultant / Educational supervisor familiar with your clinical development. Please provide NHS email addresses where possible.

Your clinical and academic referees should be contacted by you in advance to confirm that they are willing to provide a reference and are available to do so in the time period required for selection and appointment.

Please ensure these details are correct as you will be unable to begin in post until references are supplied and checked.

Reference 1 (Present or most recent Consultant / Educational Supervisor)

Please give full address

Post Details (post held by applicant)

Specialty Start Date

Level End Date

Consultant / Educational Supervisor

Name

Job title

Address

Town

County

Post code

Country

Telephone number

Fax Number

Email address


Reference 2




Level End Date


Name

Job title

Address

Town

County

Post code

Country

Telephone number

Fax Number

Email address

Reference 3




Level End Date


Name

Job title

Address

Town

County

Post code

Country

Telephone number

Fax Number

Email address


Entry Criteria checklistYou should select the following checklist to indicate that you have completed this application form in conjunction with the entry criteria set out in the relevant Specialty / entry level Person Specification for the post applied for.

Entry Criteria

I meet the entry qualifications ---Please Select---

I have the right to work in the UK ---Please Select---

I have no fitness to practice restrictions, or any other prohibition, limitation or restriction which would prevent me from applying for this post

---Please Select---

I am proficient in English Language Skills at the required level ---Please Select---

The Deanery is currently seeking advice on whether it is classified as an Employment Agency for the

purposes of the Employment Agencies Act 1973 (“the Act”) and associated regulations. In the meantime,

you are notified of the following terms and conditions that will apply to the provision of services by the

Deanery in connection with the recruitment of junior doctors to training programmes.

1. The services provided include a work-finding service for which the Act prohibits the Deanery

from charging a fee.

2. The services provided by the Deanery will be provided without any charge to either junior

doctors or the NHS employers that engage them.

3. If it is determined that the Act applies to the Deanery, the Deanery will operate as an

employment agency in providing the services.

4. The Deanery is authorised to act for NHS employers that are offering training posts as part of

the junior doctor training programme and is not authorised to enter into contracts with junior

doctors on behalf of those employers.

By proceeding with the application process you are deemed to accept these terms and conditions.

Please note, PART ONE of this form is for office use only and will not be seen by the shortlisting panel and will not form any part of the interviewing process.

Candidate Number: ___________________

APPENDIX A

Country of Origin


AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguilaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahranBangladeshBarbadosBelarusBelgiumBelizeBerinBermudaBhutanBoliviaBosnia&HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongo (Republic of)Cook IslandsCosta RicaCôte d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast Timor

EcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuineaGuinea BissauGuyanaHaitiHeard and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIran (Islamic Republic)IraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLaoPeoplesDemocratic RepublicLatviaLebanonLesothoLiberiaLibyan Arab JamahiriyaLiechtensteinLithuaniaLuxembourgMacau

MacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesia(Federated States of)MoldovaMonacoMongoliaMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherland AntillesNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandsNorth KoreaNorthernMariana IslandsNorwayOmanPakistanPalauPalestinianTerritory (Occupied)PanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarReunionRomaniaRussian FederationRwandaSaint Kitts and NevisSaint LuciaSaintVincent and the GrenadinesSamoaSan Marino

San Torne and PrincipeSaudi ArabiaSenegalSeychellesSierra LeoneSingaporeSlovakia(Slovak Republic)SloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and South Sandwich IslandsSouth KoreaSpainSri LankaSt HelenaSt Pierre and MiquelonSudanSurinameSvalbard and Jan Mayen IslandsSwazilandSwedenSwitzerlandSyrian Arab RepublicTaiwanTajikistanTanzaniaThailandTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited States of AmericaUnited States Minor Outlying IslandsUruguayUzbekistanVanuatuVatican City State (Holy See)VenezuelaVietnamVirgin Islands (British)Virgin Islands (U.S.)Wallis and Futuna IslandsWestern SaharaYemenYugoslaviaZambiaZimbabwe


Please complete this application form carefully. CVs and additional pages will not be accepted.


Deaneries

APPLICATION FORM

SPECIALTY TRAINING PROGRAMME IN PAEDIATRIC RADIOLOGY (080/56)

PART TWO

Section H (1) Entry Criteria

Medical school / university Dates

Basic Medical Qualification

Registration with the General Medical Council

Type of registration GMC number Renewal date Name in which you are registered

Experience

Do you have a minimum of 1 year post registration clinical experience ---Please Select---

Essential CriteriaPlease give answers to the following (more detailed information is requested later)

Do you have :

FRCR or eligible to be registered as a Specialist with the GMC ---Please Select---

4 years specialist training (or equivalent) in Radiology by time of taking up post ---Please Select---

A completed Audit in the last 24 months of your clinical experience ---Please Select---

A certificate of completion of resuscitation training in the last 3 years of your clinical experience

---Please Select---

Section H (2) – Professional Qualifications

Shortlisted candidates will be required to bring original certificates to the interviews

Degree / Diploma / Postgraduate qualifications (include BSc, MBBS, MRCP, MRCS etc) – state class of degree awarded

Awarding body Date of qualification


Radiology qualifications (include only those parts which have been passed)

Please give details of any research degree (MD, PhD) currently being undertaken

Section I – Present EmploymentEmployer’s / NHS Trust name :

Address :

Telephone number :

Current position – please state if locum position

Specialty GradeDate appointed

Length of contract

Length of notice required

National Training Number


Section J – Previous AppointmentsPlease list posts in chronological order (most recent first) and state if locum / temporary / substantive posts.Please asterisk those posts in the specialty for which you are currently applying.

Specialty, Hospital, Consultant Grade Date from

Date to Months in post

Please explain any gaps in your employment history


Section K – Clinical Knowledge and ExperiencePlease list here those procedures you can perform which you feel are relevant to your career in Radiology. Please also state the level of competence achieved, ie unsupervised / indirect supervision / direct supervision.

Name of procedure Details

Resuscitation TrainingIndicate date and place of training experience


Section L – Aims and career objectivesPlease indicate the reasons why you wish to pursue a career in Radiology and indicate your specific educational objectives for the post. Why should you be selected for progress to CCT? (maximum 100 words)

Section M – Audit and Managementa) Please describe your experience of clinical audit within the last 2 years of your clinical practice. Indicate

clearly your own level of involvement and the clinical relevance of the audit.

b) What methods do you personally and your Trust management use to ensure the quality of your professional performance?


c) Give a recent example of a clinical situation in which you feel team working could have been improved (up to 100 words)

d) Please list positions of administrative responsibility / leadership inside and outside of medicine.

e) Indicate how your activities outside medicine will contribute to your career in Radiology.

Section N – Academic Achievementsa) Undergraduate and postgraduate prizes or other academic distinctions


b) Publications (shortlisted candidates will be asked to bring copies of all publications to the interview). Please list your best 5 publications with full citation and PubMed number. Please asterisk those for which you are first author

c) Presentations / posters at national or international meetings. Please indicate whether N – national or I – international

d) Experience of teaching (including outside medicine). What do you offer as a teacher?

Section O – Any Further Information Relevant to this Application


Section P - Notes

1 Children and Vulnerable Adults

Where the appointment involves substantial access to children and /or vulnerable adults, the appointment is subject to a police check. The Criminal Records Bureau will be asked to verify that you have no convictions and cautions or pending prosecutions, convictions, cautions and bind-over orders. This will include local police force records in addition to checks with the Police National Computer and the government department lists held by the Department of Health and Department for Education and Employment, where appropriate.

2 Declaration

If you are related to a member or Senior Officer/Manager of the Trusts involved in the training programme, you must disclose such a relationship. You are also required to declare any involvement, either directly or indirectly, with any firm, company or organisation which has a contract with Trusts involved in the training programme. Failure to declare any information on these matters may result in your application being rejected or, if it is discovered after appointment that such information has been withheld, then this may lead to dismissal. Please note canvassing of a Senior Officer/Manager shall disqualify an applicant. Please state any disclosure/declaration related to the above on a separate sheet.

Section Q - Equal OpportunitiesThe London Deanery aims to promote equality of opportunity and is committed to treating all applicants for positions fairly and on merit regardless of race, national origin, gender, gender reassignment, marital status, civil partner status, religion, disability, sexual orientation or age.

Section R – Accepting an AppointmentYou must take up any post, including a locum post, you have formally accepted unless the employer has adequate time to make other arrangements. (Good Medical Practice published by the General Medical Council – 3 rd edition, May 2001). Failure to comply with this requirement may result in a complaint to the GMC.

Section S - SignatureI confirm that I have fairly and honestly completed this application by myself, without significant help or input from other sources. I understand that my application form will be checked, and if it is subsequently discovered that any statement is false, misleading or copied from another source, or that I have withheld relevant information, particularly on criminal convictions and fitness to practice, my application may be disqualified and / or my employment terminated. This may result in a referral to the General Medical Council / General Dental Council or other relevant professional body.

I understand that employment offered in this training programme is subject to satisfactory Occupational Health clearance and subject to the information provided on the application form or any other document being correct

The Data Protection Act 1998 requires us to provide you with certain information and, in certain circumstances, to obtain your consent before processing data about you. Processing includes: obtaining, recording, holding, disclosing, destruction and retaining information.

The information that you provide on this application form will be processed in accordance with the Data Protection Act 1998, and will be used for recruitment and if you are successful, will form part of your training record at the Deanery.

If you are appointed, the information will be passed to your employing trust. Information relating to your name, contact address, email address, date of birth, GMC/GDC registration, specialty, grade and your photograph will be passed to the Department of Health & NHS Employers for the production of an Occupational Health Smartcard.

I understand and agree that the information provided on this form being entered onto the Deanery’s computer information system and used for the Deanery’s legitimate business.

Please do not complete this signature electronically. If you are invited to interview you will be asked to sign a paper copy at that stage.

Signature Date


To the applicant : this shows the scoring system to be used for short-listing from the application form. If the short-listing panel agrees that you have scored “0” in any of the essential criteria this means that you have not provided sufficient evidence to demonstrate the attribute. You therefore cannot be shortlisted. You are advised to self-assess yourself prior to application and to seek advice from your educational supervisor if necessary. This should not be returned with your application. It is for your information only.


APPLICATION FORM

SPECIALTY TRAINING PROGRAMME IN PAEDIATRIC RADIOLOGY – SHORTLISTING SCORESHEET

NB All entry criteria must be met by date of shortlisting committee

ENTRY CRITERIA Assessed In Section YES/NO ESSENTIAL CRITERIA

Eligible for registration with the GMC B To be confirmed by Deanery

Has this applicant scored a 0 in any of the essential criteria?

YES / NO

MBBS (or equivalent) H (1) If an applicant scores 0 in any of the essential criteria, the application must be discussed at the shortlisting committee

FRCR or eligible to register as a Specialist with the GMC H (1)

4 years satisfactory completion of specialist training by time of taking up post

H (1)

ESSENTIAL CRITERIA Maximum Score (Range 0 –2)

Applicant’s score

Assessed in this Section of the Application Form

DESIRABLE CRITERIA Maximum Score (Range 0 – 2)

Applicant’s score

Completed audit in last 2 clinical years 1 H (1), M (a)

Resuscitation training (in last 3 clinical years)

1 H (1)

Radiology experience 2 H (1), I & J

H (2) BSc (I or II:I, MSc, Research MD / PhD 2

H (2) MRCP, MRCS or equivalent 2

I & J Broad appropriate clinical experience 2


ESSENTIAL CRITERIA Maximum Score (Range 0 –2)

Applicant’s score

Assessed in this Section of the Application Form

DESIRABLE CRITERIA Maximum Score (Range 0 – 2)

Applicant’s score

I ,J & L Appropriate progression of career 2

Experience of procedures 2 K

L, M (e) Commitment to a career in Radiology 2

M (a) Active involvement in Audit 2

Knowledge of clinical risk management 2 M (b) Understanding of clinical governance 2

Experience of working in multi-professional teams

2 M (c-d) Demonstrates leadership / administrative responsibility 2

N (a) Prizes and honours 2

N (b) Publications 2

N (c) Presentations 2

N (e) Experience of teaching. Enthusiasm for teaching, exposure to different groups / teaching methods

2

Communication skills 2 AF Appropriate Information Technology skills 2

Demonstrates analytical / scientific approach

2 AF Demonstrates breadth of awareness 2

Total number of points (Maximum - 42) points scored ______________________

Minimum number of points required to be considered for short-listing is 18

Please note that if an applicant achieves this score he/she will not automatically be short-listed. This is the minimum standard which must be achieved, but the final shortlist for interview will also reflect the ranking of applicants applying on this occasion.

Any attributes which are evaluated on the basis of the application form alone may be further explored at the interview stage

Documents

Paediatric Radiology Candidate Pack (080/56)