Surrey/Sussex Region - Summer Student Application 2021
You'll need to register / create or signin into a google account in order to fill this form (but you can use your normal email address for correspondence)

This application works best if you use google chrome to complete it

This application covers some of the hospitals within the Surrey/Sussex region. These include;

1. Brighton and Sussex University Hospitals NHS Trust - Royal Sussex County Hospital (Brighton) & Princess Royal Hospital (Haywards Heath)
2. East Sussex Healthcare NHS Trust - Eastbourne District Hospital & Conquest Hospital (Hastings)
3. Surrey and Sussex Healthcare NHS Trust - East Surrey Hospital

The deadline for completing this application is 31st January 2021 (applications are time / date stamped)

If you are successfully shortlisted for interview, you will hear from us by 12th February 2021

Virtual interviews will held during the week commencing 1st March 2021

You will be given a timeslot if you are successfully invited to interview.
Email address *
Sussex (and Surrey) area map
Your details
Surname *
First name *
Date of Birth *
Mobile telephone number *
Have you any unspent criminal convictions or bind-overs, or any cautions, warnings or reprimands? *
If yes please give details
Have you at any time received or had pending a criminal conviction, caution, warning, reprimand or bind-over? *
If yes please give details
Does your name appear on the Protection of Children Act List? *
Does your name appear on the Protection of Vulnerable Adults List? *
Are you a candidate signed up for to the "Guaranteed interview scheme" for people with disabilities? *
Hospital Choice
Which Trust would you pick as your 1st choice to have a summer placement? *
Which Trust would you pick as your 2nd choice to have a summer placement? [Please pick a different choice to your 1st choice] *
Do you have any particular weeks / months during the summer you are available for the summer placement? If you are free all summer please state "AVAILABLE ALL SUMMER" *
A levels - subjects & grades *
School of Pharmacy you are studying at? *
Can you confirm you are currently a 3rd year Pharmacy Student? *
References & Work Experience
Reference 1 (Academic): Include name, job title, email, telephone *
Reference 2 (Non-academic): Include name, job title, email, telephone *
Previous Work Experience 1: Include employment date, your job title, responsibilities *
Previous Work Experience 2: Include employment date, your job title, responsibilities *
Personal Statement
Please use the following sections 1-4 for your personal statement. Please list any additional information that you feel is relevant to support your application. 200 words maximum per section question
1. What experience/knowledge do you already have that you would like to build on during this summer placement? (200 words max)
2. What skills and attributes do you possess? How would you aim to improve these during your placement? (200 words max)
3. What are the reasons for your interest in working in hospital pharmacy and in your chosen hospital(s) (200 words max)
4. What are your main interests outside work? (200 words max)
Other information
Subject to availability, would you require accommodation? *
Do you have access to a car if cross-site visits are required? *
Declaration - The information in this application form is true and complete. *
A copy of your responses will be emailed to the address you provided.
Never submit passwords through Google Forms.
This form was created inside of University of Portsmouth Staff.