Self Referral Form - Doctors Programme
Please complete and submit
Email address *
Please write your surname (family name) *
Please write your first name(s) *
Please write your Postcode *
Please write your Address *
Mobile Number *
Date of Birth *
MM
/
DD
/
YYYY
Are you? *
What is your residency status? *
Do you have, or have access to your Medical Qualifications / Certificates? *
What is your country of origin? *
What country did you complete your medical degree? *
What is your English Level? *
Are you? (Tick all that apply) *
Required
Please write here any other information you would like to add
Please read and agree to our Terms and Conditions Terms and Conditions. I confirm I have read, understand and agree to the Terms and Conditions of use as put forward by Bridges Programmes. Bridges Programmes provides employment support to anyone who has English as a second language. We specialise in providing high quality training. To join us, please submit this form. How we use your information: We collect information about you so that we can support your employment search and provide a tailored service to you. This personal data includes identifiers such as names and date of birth, qualifications, service and employment history. We will keep copies of any correspondence we have with you relating to your training, GMC registration or job search. Bridges Programmes will not share your information with third parties, unless you agree to this, and will use it only for the purposes you have agreed to. We do our best to keep your data accurate and up to date, to the extent that you provide us with the information we need to do so. If your data changes (for example, if you have a new email address), then you are responsible for notifying us of those changes. We take reasonable and appropriate measures to protect Personal Information from loss, misuse and unauthorised access, disclosure, alteration and destruction, taking into account the risks involved in the processing and the nature of the Personal Information. We aim to keep our data secure, but if a security breach causes an unauthorised intrusion into our system that materially affects you we will notify you as soon as possible and later report the action we took in response. Once you have left the programme, we will retain your information for two years and will then delete your details and all correspondence with you. You may of course, re-register with us at any time. You can see the information we hold about you by contacting: Amanda Crawford, Bridges Programmes, amandacrawford@bridgesprogrammes.org.uk You can also have your information deleted at any time by contacting Amanda Crawford. *
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy