Personal Information:


Title:
Mr Mrs Miss Ms Dr Other


Full Name:


Address and Postcode:


Tel:


Email:





Education:


Degree (please inc: subject, class, dates and university):
             

Post Graduate Qualifications:





Work and Training:


Current and Previous Posts (in brief):
             

Teaching and/or training experience (if applicable):


Publications (if applicable):





Rate Yourself:


I have extensive clinical experience:                                
1 2 3 4 5 6 7 8 9 10

I have a good academic knowledge:                                
1 2 3 4 5 6 7 8 9 10

I tend to take a positive and constructive view of people and things:                                
1 2 3 4 5 6 7 8 9 10

I would be a very pleasant person to spend three days with under any circumstances, thanks to my personality and temperament, and the fact that I am east to listen to:                                
1 2 3 4 5 6 7 8 9 10

I am thoroughly conscientious and reliable:                                
1 2 3 4 5 6 7 8 9 10

I am generally well thought of by my peers:                                
1 2 3 4 5 6 7 8 9 10

I am not badly thought of by any peers:                                
1 2 3 4 5 6 7 8 9 10

I am generally well thought of by my peers:                                
1 2 3 4 5 6 7 8 9 10

My voice is clear, expressive and pleasant:                                
1 2 3 4 5 6 7 8 9 10




Referees:


Please give the names and addresses of 2 referees. One should be your current line manager, the other should be your immediately previous line-manager.


Referee 1:
             

Referee 2: