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Locum Registration
United Kingdom
Name
Date of Birth (dd/mm/yyyy)
Address
Country
---------
United Kingdom
Ireland
Region
---------
London
Midlands
North East
North West
Scotland
South East
South West
Wales
Yorkshire
Northern Ireland
Location
Post code
Transport
How far are you willing to travel? (Miles)
Happy to travel and stay over?
Mobile Number
Email
What regular days are you available?
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Qualifications
Pharmacist
ACT
NVQ3
NVQ2
GPHC Registration number (if Applicable)
Which PMR systems you can use?
PharmaSys
Pharmacy Manager
Proscript
Nexphase
Compass
AAH Link
EMIS
SystmOne
RxWeb
JAC-NHS
Analyst
Mclernons- Northern Ireland Only
Passport
File cv
UK Visa page (if Applicable)
Visa Expires (dd/mm/yyyy)
File qualification
Proof of Qualifications (second file)
Do you have a DBS/CRB?
DBS Number (if applicable)
Date DBS expires (dd/mm/yyyy)
Professional Reference: Name
Professional Reference: Designation
Professional Reference: Telephone Number
Professional Reference: Email
Safeguarding certificate
Dementia self-certification
National Insurance Number
Job role
---------
Pharmacy Assessor
Independent Prescribing Pharmacist
Locum Pharmacist
Locum Dispenser Technician
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