West of Scotland Training Programme In

NHS EDUCATION FOR SCOTLAND WEST OF SCOTLAND REGION

SPECIALIST REGISTRAR POST IN BREAST DISEASE (ONCOPLASTIC FELLOWSHIP)

POST REFERENCE: WOS/10032017

This post provides training in all aspects of the management of Breast Disease. Training will include the management of symptomatic and screen- detected disease as well as exposure to the full range of reconstructive techniques. This post is recognised as part of the West of Scotland Training Programme in General Surgery. The post will run from August 2017 for one year only.

Applicants must have completed Basic Surgical training and possess FRCS (UK), AFRCS (UK) or AFRCS (I).

The Postgraduate Dean confirms that this programme has the required educational and Postgraduate Dean’s approval.

The post is designed for trainees who hold a National Training Number and are already on a Surgical training programme and wish to undertake specialist training in Breast Disease.

Application packages are available from:

Sarah Bowman Surgery & Diagnostics Team NHS Education for Scotland, West of Scotland Region, 3rd Floor, 2 Central Quay, 89 Hydepark Street, Glasgow, G3 8BW.

E-Mail: [email protected]

Application packages can also be downloaded via the Link on the following website: http www.nes.scot.nhs.uk

Closing Date: 31/03/2017 Interviews: 28/04/2017

Working towards equal opportunities.

G/R&S/SpR/Appdetails/Howtoapp/5/9/2018 NHS EDUCATION FOR SCOTLAND WEST OF SCOTLAND REGION

SPECIALIST REGISTRAR IN BREAST DISEASE (ONCOPLASTIC FELLOWSHIP)

Ref: WOS10032017

JOB DESCRIPTION

1. INTRODUCTION

This Specialist Registrar post in Breast Disease forms part of the Surgical Training Programme in General Surgery. This post will run from August 2017 for one year only. It has training approval from the Postgraduate Dean and Joint Committee in Surgical Training.

The trainee’s education and progress is supervised by the Surgical

Training Committee and by designated supervisors in each hospital

involved in the programme. The Surgical Training Committee comprises

the Regional Education Adviser, Trust Representatives, University and

Junior Staff Representatives. Individual trainees are required to sign a

training programme agreement, and performance assessment is carried

out on a regular basis throughout training. Summative assessment is

conducted annually and is based on in-house training assessment

criteria laid down by the JCST. Study Leave conforms with terms and

conditions of service for the Specialist Registrar grade.

The aims of the post is to provide training in the subspecialty of Breast

Surgery with emphasis on Oncoplastic training. The post is ideally suited

to a higher surgical trainee in year 5 or 6 who is committed to a career in

the management of breast disease.

G/R&S/SpR/Appdetails/Howtoapp/5/9/2018 2. ENTRY REQUIREMENTS

The Trainee will be appointed by a Committee comprising

representatives of the Postgraduate Dean, Specialty Training

Committee, teaching hospitals, district hospitals, University of Glasgow

and National Panel of Specialists.

Applicants should already be on a Surgical Training Programme. All

trainees will require to have completed basic surgical training and to hold

the diplomas of MRCS/FRCS/AFRCS or equivalent. The post is

designed for trainees who hold a National Training Number Applicants

will be expected to provide evidence of their competence to

communicate in English.

3. DUTIES OF THE POST

Training

The Trainee must make full use of the training opportunities provided in

each placement.

Clinical

The Trainee will be expected to participate fully in the clinical work of the

department, including the pre- and post-operative care of patients.

He/she will be expected to extend and improve their surgical skills and

be involved in on-call rotas for the majority of clinical attachments.

Supervision by Consultant Staff will always be available.

Emergency surgery will be undertaken as part of this post by

participation in the emergency surgical rota at the hospital in which the

trainee is based.

G/R&S/SpR/Appdetails/Howtoapp/5/9/2018 Administration

The Trainee will be expected, when appropriate, to participate in the day

to day running of the department in administrative activities such as

organisation of on-call rotas, organisation of undergraduate training,

patient reports and letters. The Trainee will have the opportunity to

develop management skills as required by the JCST.

Communication

This will include:

Discussion with relevant Consultants regarding clinical problems.

Communication with General Practitioners – this will include telephone

discussion of problems and writing of letters about cases seen in the

Department.

Liaison with Specialists in other hospitals/agencies such as district

nurses, ambulance, police, etc.

4. EDUCATION

Continuing Education

The Trainee will be expected to participate in educational activities on a

local and national basis.

All hospitals enjoy well stocked departmental libraries and in addition

comprehensive education facilities.

Education leading to the intercollegiate FRCS is available through in-

house tutorials and locally arranged postgraduate courses. Trainees are

expected to further their education through attendance at meetings and

courses held both locally and nationally.

Management development is encouraged and the Trainee will be

expected to attend appropriate courses.

G/R&S/SpR/Appdetails/Howtoapp/5/9/2018 Teaching

At the appropriate stage of training, the Trainee will be expected to take

part in departmental teaching for junior staff, undergraduates, nursing

staff, etc

5. RESEARCH AND AUDIT

Research

There is a strong tradition of research in the West of Scotland. Facilities

and support for research activities are available through the University

academic department and within hospital departments. The trainee will

be encouraged to participate in clinical research and time will be

allocated consistent with current Terms & Conditions.

Audit is an essential component of Surgical practice and the Trainee will

be required to participate in local and national audit activities.

6. LOCATION OF DUTIES

The hospitals involved in the training programme are as follows:

Canniesburn Plastic Surgical Unit, Royal Infirmary, Glasgow

Gartnavel General Hospital

7. ASSESSMENT

The Trainee will be continuously assessed by the trainers in their place

of work with formal interviews every 6 months and annual review by the

Surgical Sub-Committee of the West of Scotland Postgraduate Medical

Education Board.

G/R&S/SpR/Appdetails/Howtoapp/5/9/2018 If, in the opinion of the Surgical Training Committee, the Trainee fails to

show adequate commitment or progress, career guidance will be

arranged, and exceptionally, in the absence of satisfactory progress, the

committee may recommend that the contract be terminated.

Trainees are required to keep a portfolio and logbook following the

requirements laid down by the JCST

8 GENERAL INFORMATION

Hours and Salary

The hours of duty will be the standard working week of 40 hours for which a standard salary (as detailed in paragraph 8b, Appendix 1 of the Terms and Conditions of Service, appended under general information) will be paid.

From December 1st 2000, a new system for calculating Junior Doctor's out of hours pay was introduced, the 'Banded Intensity Contract'. The standard hours of duty will remain 40 hours per week and in addition a supplement will be paid. The banding for the hospitals on the rotation will be confirmed on appointment.

Please note that a monitoring exercise is currently being undertaken,

therefore, the current Banding may be subject to change. An offer of

Employment may not reflect the current Banding.

Further Information

For further information regarding the training programme, please contact:

Mr. C R Wilson, Training Programme Director and Consultant Breast Surgeon,

Gartnavel General Hospital, Glasgow.

Telephone: 0141 301 9859

G/R&S/SpR/Appdetails/Howtoapp/5/9/2018 Ms J C Doughty, Consultant Breast Surgeon, Gartnavel General Hospital,

Glasgow

Telephone: 0141 301 9858

Mr. J H Anderson, Chair of the Surgical Training Committee and Consultant

Surgeon, Glasgow Royal Infirmary, Glasgow

Telephone: 0141 211 5439

Miss E Mithoff, Consultant Plastic Surgeon, Canniesburn Unit, Glasgow Royal

Infirmary,

Telephone: 0141 211 5798

Mr. B Chew, Consultant Plastic Surgeon, Canniesburn Unit, Glasgow Royal

Infirmary

Telephone: 0141 232 1070

Mr. A Malyan, Consultant Plastic Surgeon, Canniesburn Unit, Glasgow Royal

Infirmary

Telephone: 0141 211 5798

Ms S Stallard, Consultant Breast Surgeon

Telephone: 0141 301 9857

G/R&S/SpR/Appdetails/Howtoapp/5/9/2018 APPENDIX

OUTLINE OF PROPOSED PROGRAMME

SPECIALIST REGISTRAR IN BREAST SURGERY

Canniesburn Plastic Surgical Unit

INTRODUCTION

Glasgow has a National and International reputation for the management of all

aspects of Breast disease and in recent years has developed a fully integrated model

for the provision of and training in Oncoplastic Breast techniques.

This model of Oncoplastic Breast Surgery relies on the close working relationship

between the Plastic Surgeons and Breast Surgeons in Glasgow. This has resulted in

excellent training opportunities for our local trainees who spend at least 6 months

dedicated Breast Plastic Surgical Training in the Canniesburn Unit.

The establishment of an interface group of the two SACs to process this approach has

highlighted the combination of general and plastic training in breast surgery.

We are, therefore, able to offer the full range of specialist training in breast surgery as

outlined by the curriculum devised by the SAC in general surgery in a new combined

unit of surgeons who have nationally recognised expertise. This could provide

appropriate experience in the management of breast disease for both general and

plastic surgery trainees.

G/R&S/SpR/Appdetails/Howtoapp/5/9/2018 The unit has an international reputation for its clinical and basic research and this is

reflected by the prominent role that many of the units play in the organisation of breast

cancer and other cancer services in Scotland and the rest of the UK

STAFFING

Ms J.C Doughty

Mr. C R Wilson

3 Nurse Specialists

Canniesburn Unit, Glasgow Royal Infirmary

Miss E Mithoff

Mr. A Ray

Mr. J Scott

Mr. A Malyon

Ms M Strick

G/R&S/SpR/Appdetails/Howtoapp/5/9/2018

Multidisciplinary Team

Close working relationships with other specialists within a multidisciplinary team are a key part of modern breast cancer management. This is long established in our practice, we are fortunate to collaborate with a number of outstanding clinicians, many of whom are recognised nationally.

Pathology

Dr E Mallon

Radiology

Dr P Law

Dr J Litherland

Dr H Griffiths

Oncology

Dr G Fraser

Dr J Fraser

Dr I MacPherson

Dr M Rizwanallah

UNIT CLINICAL PROGRAME

 Multidisciplinary One Stop Assessment Clinics  Breast Screening Assessment Clinics  Genetic Evaluation and High Risk Clinics  Breast Cancer Planning and Results Clinics  Follow up Clinics  Breast Reconstruction and Oncoplastic Assessment Clinics  Symptomatic Breast MDT  Breast Screening MDT  Symptomatic Breast Theatre Sessions (Combined with Endocrine Cases)  Impalpable Screen Detected Theatre Sessions  Oncoplastic / Immediate / Delayed Reconstructive Theatre Sessions

G/R&S/SpR/Appdetails/Howtoapp/5/9/2018 Clinical Workload

Approximately 4000 symptomatic new breast patients per year are assessed in two on-

stop diagnostic clinics and in excess of 400 breast cancers are treated which includes

150 screen-detected cancers. A further 50 patients with breast cancer are treated non-

surgically with primary medical therapy. Sixty-five per cent of patients have

conservation surgery and 30 pr cent of those undergoing mastectomy have immediate

reconstruction in conjunction with the plastic surgery team. In excess of 150

localisation procedures are performed for impalpable lesions. We have been at the

forefront in the UK of developing new surgical techniques.

Canniesburn Plastic Surgical Unit

There are more than 500 new referrals per year for reconstructive surgery and

approximately 200 immediate and 200 delayed reconstructions are performed annually.

This allows ample opportunity for training in all aspects of ‘oncoplastic surgery.

Training Opportunities

The workload, range of activity, level of specialisation and supervision allows for

provision of specialist training. Appropriate supervision is always available from the

consultants involved in the management of breast disease. Training is available in

palpable and unpalpable breast disease and also breast reconstruction

Research

Research is fundamental to clinical training and remains the requirement for the

Intercollegiate FRCS examination. Out unit has developed an international reputation

in both clinical and basic research. All trainees are encouraged to take an active part

in this, and in recent years have all presented work at national and international

meetings.

Clinical Research

Clinical trials are a central part of the development of our specialty and the unit is

strongly committed to them. Members of the team are on the supervisory committees

G/R&S/SpR/Appdetails/Howtoapp/5/9/2018 for several other national and international trials. Patients from our practice are actively recruited into the trials and a trainee is expected to be part of this process.

Numerous other clinical projects are carried out in the unit for which we have a high rate of success in converting these for presentation at clinical meetings and for publication.

Basic Research

We have a strong framework of basic breast cancer work within the academic department and our research is recognised internationally. There are strong collaborative links with the Department of Pathology and the Beatson Institute. It is not unusual for clinical trainees to do laboratory work during the clinical training, as they are encouraged to take an interest in it and to make an intellectual contribution.

Proposed Timetable

This appointment should have particular emphasis on the techniques and assessment for Oncoplastic Surgery which will be gained by working within the model of care between the Gartnavel General Hospital and the Canniesburn Unit. This would provisionally involve spending time between the Gartnavel General Hospital and

Canniesburn Plastic Surgery Unit, Glasgow Royal Infirmary, but during that time there can be flexibility depending on the educational and training requirements of the trainee.

G/R&S/SpR/Appdetails/Howtoapp/5/9/2018 NHS EDUCATION FOR SCOTLAND – WEST OF SCOTLAND REGION

PERSON SPECIFICATION

SPECIALTY General Surgery – Breast Disease

The person specification is used for both shortlisting and selection purposes for recruitment to training programmes. The aim of the process is to recommend for appointment people who have the potential to develop at specialist level and who have demonstrated the achievement of educational and training objectives within an appropriate timescale.

FACTOR ESSENTIAL DESIRABLE

EXPERIENCE 2 years basic surgical training in posts Additional experience in General Surgery approved by Royal Colleges of Surgeons in Additional experience in Plastic Surgery UK & Ireland or equivalent

Already on a higher surgical training programme at years 5 and 6 with experience in breast surgery

QUALIFICATIONS MBChB or equivalent Higher Degree

TRAINING FRCS/MRCS/AFRCS

RESEARCH Demonstrate an interest in research

PUBLICATIONS Evidence of relevance of research Relevance of Publications to specialty

NTN Number

KNOWLEDGE Skills appropriate to experience Potential to develop AND SKILLS Experience of Clinical Audit

Evidence of Enthusiasm for teaching

DISPOSITION Evidence of organisational and Commitment to team working. e.g. Personal communication skills. (transferable) Ability to prioritise when under pressure skills Ability to see a project through to completion

Leadership qualities

Prepared to rotate as specified. OTHER Evidence of Hepatitis B immune status.*

Pre-employment health screening.**

Registered with GMC/GDC.***

* If appropriate this will be forwarded to the Lead Trust along with a completed health questionnaire.

G/R&S/SpR/Appdetails/Howtoapp/5/9/2018 ** Appointment will be subject to satisfactory pre-employment health screening carried out by the Lead Trust following recommendation for appointment. *** Candidates will be asked to provide documentary evidence of their GMC/GDC registration at the interview.

G/R&S/SpR/Appdetails/Howtoapp/5/9/2018 NHS EDUCATION FOR SCOTLAND WEST REGION

HOW TO MAKE YOUR APPLICATION

SPECIALIST REGISTRAR IN BREAST DISEASE (ONCOPLASTIC FELLOWSHIP)

Reference Number: WOS/10032017

Please note this post will run from August 2017 for one year only

Thank you for expressing an interest in the training programme. You will find enclosed information which relates to this post, as well as application details.

Please read the enclosed guidelines before submitting your application.

Please include the following documentation with your application:

 7 copies of your CV } Failure to complete this statement will result

 1 copy of the Declaration Statement - } in your application being withdrawn.  1 copy of the Training Programme Application  1 copy of the Equal Opportunities Monitoring form

You must submit the fully completed training programme application to accompany your CV. The declaration statement should be sealed in a labelled envelope. Failure to complete these forms or failure to include relevant information in the CV and application as requested, may lead to your application being withdrawn.

Please refer to the guidelines overleaf for completing your CV.

Please ensure that your CVs are collated and stapled (not bound) before being submitted, as applications shall be presented to the Appointments Committee in the format in which they are received.

Once completed your training programme application and copies of the documentation requested above should be submitted to:

Ms S Bowman Surgery & Diagnostics Team NHS Education for Scotland West of Scotland Region,2 Central Quay 89 Hydepark Street, Glasgow G3 8BW Telephone: 0141 223 1451

Closing date: 31/03/2017 Interviews: 28/04/2017

Please ensure when returning your application details that postage is fully paid as we cannot accept delivery where payment requires to be made.

G/R&S/SpR/Appdetails/Howtoapp/5/9/2018 GUIDELINES FOR COMPLETING YOUR CV

Information on marital status, number of children, nationality and secondary schooling should NOT be included in your CV. Your application will be shortlisted on the basis of the information contained in your CV and it is therefore essential that you provide the information detailed below in the order presented.

QUALIFICATIONS

Basic Qualification - State clearly your basic qualification, indicating the month and year of achievement.

Medical School - Indicate the name of the medical school from which you received your basic qualification with dates.

Academic Distinctions and Awards - This includes honours degrees, higher degrees and prizes awarded by Universities along with the dates awarded.

Other Qualifications and Awards - This includes higher diplomas awarded by Royal Colleges and parts of examinations along with dates awarded.

Courses attended (Medical and Non Medical) - Indicate with approximate dates, the courses you have attended.

EXPERIENCE

Present appointment with date of appointment - Give your grade and specialty together with your date of appointment. State clearly the name of your current employer.

Date upon which duties could be commenced - Please indicate a specific date or show your contract period of notice with your current employer.

Previous medical appointments held since qualification - Your previous appointments held since qualification should commence with your last appointment, including locum appointments, showing clearly the hospital and the dates for each post.

Clinical experience - Please state details of relevant clinical and audit experience, and state how this experience will benefit you in the post for which you are applying.

Managerial experience - Please indicate any managerial and organisational experience gained during your previous appointments.

Teaching experience - Indicate the level of teaching experience you have acquired and the staff groups you have taught, highlighting, where appropriate, relevance to the post.

Research experience - Give details of any research experience and exposure to research activities.

Papers presented to Learned Societies - Please list the titles of the papers and the names of the Society.

Publications - Give details of no more than three publications which you consider to be the most important and state why. You may if you wish, give a full list of publications on a separate sheet. These should be divided into abstracts, full publications, case reports and letters.

The Reason for your application State briefly the reason for your application. Outline your future professional aims, giving any additional information you wish to offer in support of your application.

G\R&S\SpR/Appdetails/EqOpps/5/9/2018 WEST OF SCOTLAND REGION

IN CONFIDENCE

TRAINING PROGRAMME APPLICATION

PLEASE PRINT IN BLACK INK

POSITION: Specialist/Specialty Registrar SPECIALTY: BREAST DISEASE (ONCOPLASTIC FELLOWSHIP) POST REFERENCE: WOS/10032017

1. PERSONAL DETAILS

SURNAME ______INITIALS ______KNOWN AS ______

CORRESPONDENCE ADDRESS ______

______

______POSTCODE ______

TELEPHONE: Work ______Bleep/Page No. ______

Home ______

Your daytime telephone number or number on which a message may be left ______

EMAIL ADDRESS: ______

2. NATIONALITY AND IMMIGRATION STATUS

PRESENT NATIONALITY: COUNTRY OF BIRTH:

Please tick the appropriate box:

If you are not a UK or EEA national, please indicate your immigration status below:

Rights of indefinite residence in UK YES  NO  From:

Permit-free status eligible YES  NO  From:

G\R&S\SpR/Appdetails/EqOpps/5/9/2018 3. REFEREES

Please give details, including title and correct style of address, of three professional referees who have consented to be approached now. They should be qualified to comment on your medical ability and experience for this appointment and should include a referee from your current or most recent employer. Unless you indicate otherwise it will be assumed that any of your referees may be approached following shortlisting.

PLEASE USE BLOCK CAPITALS CURRENT POST NAME ______

DESIGNATION ______

ADDRESS ______

______

TEL No. ______

FAX No. ______

EMAIL ADDRESS ______

4. GMC/GDC REGISTRATION TYPE

Limited or Full ______GMC/GDC No. ______

5. NATIONAL TRAINING NUMBER

DO YOU HOLD A CURRENT NATIONAL TRAINING NUMBER (NTN or VTN)? YES/NO

If yes, please state your NTN or VTN ______

SPECIALTY ______LOCATION ______

HAVE YOU EVER PREVIOUSLY HELD AN NTN OR VTN? YES/NO

If yes, please give full details of dates held, which specialty etc:

______

6. REHABILITATION OF OFFENDERS ACT 1974 G\R&S\SpR/Appdetails/EqOpps/5/9/2018 Because of the nature of the work for which you are applying, this post is exempt from the provisions of section 4[2] of the Rehabilitation of Offenders Act 1974 by virtue of the Rehabilitation of Offenders Act 1974 [Exemption Order 1975].

Applicants are therefore not entitled to withhold information about convictions which for other purposes are “spent” under the provision of the act. In the event of employment, any failure to disclose such convictions could result in dismissal or disciplinary action by your employer. If selected for interview you will be required to complete a subsequent criminal convictions declaration form.

7. CANVASSING

Canvassing directly or indirectly in connection with any appointment shall disqualify your application, or if discovered after appointment you will be liable to dismissal.

8. CONFIRMATION OF QUALIFICATIONS

Any offer of appointment arising out of this application will be subject to the examination of the original certificate(s) of relevant qualifications and membership of professional bodies.

9. DECLARATION - PLEASE READ CAREFULLY BEFORE SIGNING THIS DECLARATION

I declare that the information I have given in support of my application is, to the best of my knowledge and belief, true and complete. I understand that if it is subsequently discovered that any statement is false or misleading, or that I have withheld relevant information my application may be disqualified or, if I have already been appointed, I may be dismissed without notice.

Signature ______Date ______

G\R&S\SpR/Appdetails/EqOpps/5/9/2018 NHS EDUCATION FOR SCOTLAND

WEST OF SCOTLAND REGION

Registration with the General Medical Council or General Dental Council imposes on doctors and dentists the duty to provide a good standard of medical care for, and to behave appropriately, towards patients. NHS Employers also have a duty to ensure that patients receive a good standard of medical care and ensure as far as possible the safety of patients. We therefore need to establish if you have been found guilty of a criminal offence, been bound over or cautioned or are currently the subject of proceedings which might lead to a conviction, an order binding you over or a caution, in the UK or any other country.

Applicants for posts in the NHS are exempt from the Rehabilitation of Offenders Act 1974. We are required to ask all applicants to declare any previous or pending prosecutions or convictions, including those considered “spent” under this Act. (SEE OVER)

We also need to establish if you have been the subject of any fitness to practise proceedings in the past, or if any fitness to practise proceedings are being contemplated, by a licensing or regulatory body in the UK or another country and this is also reflected in the declaration.

This information will be treated in confidence and will not debar you from appointment unless the selection panel considers that it renders you unsuitable for appointment. In reaching such a decision the selection panel will consider the nature of the conviction/action, how long ago it took place and any other factors which may be relevant.

Failure to disclose a criminal offence, having been bound over or cautioned or that you are currently the subject of criminal proceedings which might lead to a conviction, an order binding you over or a caution, or fitness to practise proceedings undertaken or being undertaken by an appropriate licensing or regulatory body, may disqualify you from appointment, or result in summary dismissal/disciplinary action being taken by SCPMDE and referral to the General Medical Council [General Dental Council] for consideration if such a discrepancy came to light.

G\R&S\SpR/Appdetails/EqOpps/5/9/2018 NHS EDUCATION FOR SCOTLAND

West of Scotland Region

IN CONFIDENCE

Post applied for: Special Interest – Oncoplastic Breast Disease

Post Reference: WOS10032017

Declaration Statement

Please complete and return this form in a sealed envelope with your application. Failure to do so will result in your application being withdrawn.

1. Have you been convicted of a criminal offence, been bound over or cautioned or are currently the subject of any police investigations, which might lead to a conviction, an order binding you over or a caution in the UK or any other country?

YES/NO

If yes, please provide details of the criminal offence, order binding you over or caution or details of any current proceedings which might lead to a conviction, an order binding you over or a caution, including approximate date, the offence, and the authority and country which dealt with the offence.

Offence Dates Penalty a. ______b. ______c. ______d. ______e. ______

2. To the best of your knowledge have you been or are you currently subject to any fitness to practice proceedings by an appropriate licensing or regulatory body in the UK or any other country?

YES/NO

If yes, please provide details of the nature of proceedings undertaken, or contemplated, including approximate date of proceedings, country where proceedings were undertaken and the name and address of the licensing or regulatory body concerned.

G\R&S\SpR/Appdetails/EqOpps/5/9/2018 ______

I hereby declare that the information given here is true.

Name (Please Print) Signature Date

G\R&S\SpR/Appdetails/EqOpps/5/9/2018 WEST OF SCOTLAND REGION

EQUAL OPPORTUNITY MONITORING FORM - STRICTLY CONFIDENTIAL

We are committed to eliminating discrimination from recruitment and selection practices. We will take steps to ensure that candidates 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 on a local and national basis, we require the following information which would only be used for this purpose, 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 and will be kept separately in the Deanery office.

PLEASE COMPLETE IN BLOCK CAPITALS & BLACK INK

NAME AGE

TRAINING PROGRAMME / DEPARTMENT/ POST APPLIED FOR SPECIALTY

PLEASE TICK APPROPRIATE BOX

1. ETHNIC ORIGIN (Based on classifications recommended by the Commission for Racial equality)

WHITE 

INDIAN 

PAKISTANI  BANGLADESHI  BLACK - AFRICAN  BLACK - OTHER  CHINESE  BLACK - CARIBBEAN  OTHER Please specify If appointed, is a work permit required?

YES 

NO 

2. SEX

Male 

Female 

G\R&S\SpR/Appdetails/EqOpps/5/9/2018 3. DISABILITY Do you consider that you have a disability which impacts upon your working life?

YES 

NO 

If yes, please state briefly the nature of your disability

4. MARITAL STATUS

Married 

Single 

Widowed 

Divorced 

5. ADVERTISING SOURCE

Internal Notice  Word of Mouth  BMJ/BDJ  INTERNET  OTHER (please specify)

G\R&S\SpR/Appdetails/EqOpps/5/9/2018