ࡱ> G bjbjƶ ԬiԬiVM $P"Tz=&((PPP""" "<<<<<<<$?VB<Q$B"|"$$<PP="***$RlPP<*$<**N6,!9P@ĕC%Z80<>=<z=80B&B`!9B!9p"ZN#@*#4#/"""<<W(b"""z=$$$$B""""""""" X :  DENTAL FACULTY Ƶ APPLICATION FOR APPOINTMENT TO THE PANEL OF ASSESSORS FOR Ƶ DENTAL EXAMINATIONS  I wish to be considered for appointment to the Panel of Assessors for The Ƶ Dental Examinations personal details Title: ..................................................... Surname: ............................................. First Names: ................................................ Date of Birth: ............................................. Mobile Telephone: ...................................... E-mail:. Home Address: ............................................................................ ............................................................................ ............................................................................ Postcode: ......................................................... Home Telephone: ............................................. PROFESSIONAL DETAILS GDC number: .. Specialist list(s) All applicants are required to be a Fellow or Member of Ƶ and be in good standingRoll Number: Date of Election: COMPLETED APPLICATIONS SHOULD BE RETURNED BY EMAIL TO  HYPERLINK "mailto:DentalExaminerRecruitment@rcsed.ac.uk" DentalExaminerRecruitment@rcsed.ac.uk or by POST TO: The Administrator Dental Examinations Section Examination Department The Royal College of Surgeons of Edinburgh Nicolson Street Edinburgh EH8 9DW This form should be completed in TYPE. PRESENT (OR MOST RECENT) APPOINTMENT Post:..................................................................................................................................................... Date commenced: ...............................................End date . Location: ............................................................................................................................................. Address: ................................................................................................................................................................................................................................................................................. ................................................................................. Postcode ........................................... Telephone no: ...................................................... Preferred contact e-mail: ..  main specialty and sub-specialty (if any) interest  education Qualifications obtained (include degrees, diplomas, professional examinations) Examination/Qualification Year Awarding Body Year   previous appointments Covering the last ten years Location  Position heldDates FromTo  EXAMINING EXPERIENCE Professional Body Award Dates FromTo  POSTGRADUATE TEACHING/TRAINING/EDUCATION EXPERIENCE covering the last ten years. OrganisationSubjectDatesFromTo    ANY PREVIOUS EXPERIENCE AS AN EXTERNAL EXAMINER Professional Body Examination Dates FromTo GENERAL DATA PROTECTION REGULATION (GDPR) (2018) I understand that, if I am appointed, personal information about me will be held electronically for personnel/administrative purposes and statutory returns. DECLARATION I understand that the procedure of appointment is through submission to the Royal College of Surgeons of Edinburgh. If appointed, I am prepared to serve on the Panel of Assessors and agree to participate in accordance with the details in the specification for the post. I confirm that: I am/have been an Ƶ examiner for a minimum of 3 years I have examined in an Ƶ examination on at least 5 occasions I have declared any active disciplinary investigation against me I am in good standing with Ƶ I am prepared to undergo training I am prepared to serve on the Panel of Assessors for a period of five years Signed: ......................................................................................... Date: .........................  Before sending your application form, please ensure that you meet the eligibility criteria. Please also ensure that you provide two completed and signed referee forms.    May 2023      PAGE \* MERGEFORMAT 5  PAGE \* MERGEFORMAT 7 Equal Opportunities Monitoring Questionnaire CONFIDENTIAL Ƶ aims to ensure fair treatment in relation to the consideration of applicants for the Panel of Assessors. In line with UK legislation and good practice guidelines we would like to monitor our statistics and ensure that no applicant receives less favourable treatment particularly on the grounds of sex, race, colour, nationality, ethnic origin, marital status, disability, sexuality, age or religious belief. Information will only be used to monitor our administrative practices, carry out statistical analysis and ensure we provide equality of opportunity to all. The information will be recorded electronically with your other data in accordance with the General Data Protection Regulation (GDPR) (2018), and any use made of this data will not allow individuals to be identified. The organisation needs your help and co-operation to enable it to do this, but completion of the form is voluntary. Whatever your decision is, it will not affect how we process or consider your application. Gender Male * Female * Transgender * Prefer not to say * & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & . Are you married or in a civil partnership? Yes * No * Prefer not to say * & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & . Age 16-24 * 25-29 * 30-34 * 35-39 * 40-44 * 45-49 * 50-54 * 55-59 * 60-64 * 65+ * Prefer not to say * & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & What is your ethnicity? Ethnic origin is not about nationality, place of birth or citizenship. It is about the group to which you perceive you belong. Please tick the appropriate box White English * Welsh * Scottish * Northern Irish * Irish * British * Gypsy or Irish Traveller * Prefer not to say * Any other white background, please write in: Mixed/multiple ethnic group White and Black Caribbean * White and Black African * White and Asian * Prefer not to say * Any other mixed background, please write in: Asian/Asian British Indian * Pakistani * Bangladeshi * Chinese * Prefer not to say * Any other Asian background, please write in: Black/ African/ Caribbean/ Black British African * Caribbean * Prefer not to say * Any other Black/African/Caribbean background, please write in: Other ethnic group Arab * Prefer not to say * Any other ethnic group, please write in: What is your sexual orientation? 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Do you consider yourself to have a disability or health condition? Yes * No * Prefer not to say * What is the effect or impact of your disability or health condition on your ability to give your best at work? Please write in here: The information in this form is for monitoring purposes only. If you believe you need a  reasonable adjustment , then please discuss this with the manager running the Assessor recruitment process.. ............................................................................................................................................................. What is your religion or belief? No religion or belief * Buddhist * Christian * Hindu * Jewish * Muslim * Sikh * Prefer not to say * If other religion or belief, please write in: ............................................................................................................................................................. Where did you hear of this vacancy? 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