PERSONAL PARTICULARS. Agent Code
PERSONAL PARTICULARS. Surname First Name Title (Mr/ Mrs/ Other) Identity Number Trainee Number Physical Address Tel No Work ( ) Fax No ( ) Current Title Permanent/Contract Years/Months at current employer Years Months If contract when is the contract end date Name of employer/ATC Cell No Postal Address E-Mail (work) English Afrikaans Other (specify) E-mail (personal if different) Home Language Gender Postal Code Postal Code Employment Equity Profile Black Coloured Indian White Other (specify) (Compulsory fields) Are you a South African Citizen Yes No If no, specify Disability* Yes No If Yes, Specify * The Employment Equity Act 55 of 1998 defines a disability as a long-term or recurring physical or mental impairment that substantially limits prospects of entry into, or advancement in employment
PERSONAL PARTICULARS. Surname First Name Title (Mr/ Mrs/ Other) Identity Number Trainee Number or Membership Number Physical Address Municipality Province Urban/Rural Area Tel No Work ( ) Cell No ( ) Work address (Street) Province Urban or Rural work location Municipality Current Title Permanent/Contract Years/Months at current employer Years Months If contract when is the contract end date Name of employer/ATC Fax No Postal Address E-Mail (preferred) E-mail (work) E-mail (alternative) Gender Postal Code Postal Code Home Language English Afrikaans Other (specify) Employment Equity Profile Black Coloured Indian White Other (specify) (Compulsory fields) Are you a South African Citizen Yes No If no, specify Disability* Yes No If Yes, Specify * The Employment Equity Act 55 of 1998 defines a disability as a long-term or recurring physical or mental impairment that substantially limits prospects of entry into, or advancement in employment
PERSONAL PARTICULARS. Name of Applicant Registration Number Phone number Year of the study Programme Reason for Conditional Registration Date Signature
PERSONAL PARTICULARS. Surname First Name Title (Mr/ Mrs/ Other) Identity Number Trainee Number Physical Address Province Tel No Work ( ) Cell No ( ) Work address (Street) Province Urban or Rural work location Current Title Permanent/Contract Years/Months at current employer Years Months If contract when is the contract end date Name of employer/ATC Fax No Postal Address E-Mail (work) English Afrikaans Other (specify) E-mail (personal) Home Language Gender Postal Code Postal Code Employment Equity Profile Black Coloured Indian White Other (specify) (Compulsory fields) Are you a South African Citizen Yes No If no, specify Disability* Yes No If Yes, Specify * The Employment Equity Act 55 of 1998 defines a disability as a long-term or recurring physical or mental impairment that substantially limits prospects of entry into, or advancement in employment
PERSONAL PARTICULARS. Name in English : Xxxx. Xxx Xxxx Xxxxxx Xx Name in Chinese : [Chinese characters] ID/Passport No : Position held in Company/Organization : Professor Company/Organization: : The Chinese University of Hong Kong * Office Address : * Nature of Business : Tel No : 0000 0000 Fax No : 2636 5090 E-mail Address : xxxx@xxxx.xxx.xx Web Page : xxxx://xxx.xxx.xxxxx.xxx.xx/ * Not applicable to in-house personnel of the applicant. Academic/Professional Qualifications (in chronological order): Bachelor or of Arts Cambridge 1986 Bachelor of Medicine & Bachelor of Surgery Oxford 1989 Master of Arts Cambridge 1990 Doctor of Philosophy Oxford 1994 Member of the Royal College of Physicians U.K. 1995 Member of the Royal College of Pathologists U.K. 2000 Doctor of Medicine Oxford 2001 Working Experience (in chronological order): (Project management experience, if any, should be included.) Wellcome Medical Graduate Fellow 1990-3 University of Oxford Nuffield Department of Pathology & Bacteriology Welcome Clinician Scientist Fellow 1993-4 University of Oxford Nuffield Department of Clinical Medicine University Lecturer 1994-7 University of Oxford Nuffield Department of Clinical Biochemistry Fellow 1994-7 Green College University of Oxford Associate Professor 1997-2000 The Chinese University of Hong Kong Professor 2000-present The Chinese University of Hong Kong Principal investigator of grants amounting over HK$5 million over the last 5 years, successfully managing these projects. These projects have resulted in over 40 publications in peer-reviewed journals over the last 5 years. Publications (maximum five publications related to the application): Lo YMD, Corbetta N, Xxxxxxxxxxx XX, Rai V, Xxxxxxx IL, Xxxxxx XX, et al. Presence of fetal DNA in maternal plasma and serum. Lancet 1997;350: 485-7. Lo YMD, Hjelm NM, Xxxxxx C, Xxxxxxx IL, Xxxxxx XX, Xxxxxxxxxxx XX, et al. Prenatal diagnosis of fetal RhD status by molecular analysis of maternal plasma. N Engl J. Med 1998;339: 1734-8. Lo YMD, Xxx TIC, Zhang J, Xxxxx TN, Xxxxx AM, Xxxxx NM, et al. Increased fetal DNA concentrations in the plasma of pregnant women carrying fetuses with trisomy 21. Clin Chem 1999;45:1747-51. Poon LL, Xxxxx TN, Xxx TIC, Lo YMD. Prenatal detection of fetal Down’s syndrome from maternal plasma. Lancet 2000;356:1819-20. Poon LL, Xxxxx TN, Xxx XX, Lo YMD. Presence of fetal RNA in maternal plasma. Clin Chem 2000;46:1832-1834. Intellectual Property Rights (e.g. patents, copyrights. etc) Owned: (Please attach addit...
PERSONAL PARTICULARS. Name in English : Xxxx. Xxxxx Wai Xxxx Xxxx Name in Chinese : [Chinese characters] ID/Passport No : Position held in Company/Organization : Assistant Professor Company/Organization : The Chinese University of Hong Kong * Office Address : * Nature of Business : Tel No : 0000 0000 Fax No : 0000 0000 E-mail Address : xxxxxxxxx@xxxx.xxx.xx Web Page : xxxx://xxx.xxx.xxxx.xxx.xx/ * Not applicable to in-house personnel of the applicant. Academic/Professional Qualifications (in chronological order): MBBS Qld (First class honours) Working Experience (in chronological order): (Project management experience, if any, should be included.)
PERSONAL PARTICULARS. Name in English: Xxxx. Xxx Xxx XXX Name in Chinese: [Chinese characters] ID/Passport No: Position held in Company/Organization: Associate Professor Company/Organization: The Chinese University of Hong Kong * Office Address: * Nature of Business: Tel No: 0000 0000 Fax No: 0000 0000 E-mail Address: xxxxxxxxx@xxxx.xxx.xx Web Page: xxxx://xxx.xxx.xxxx.xxx.xx/ * Not applicable to in-house personnel of the applicant.
PERSONAL PARTICULARS. 26.1. Whilst working as an NHS Professional under this registration agreement, you are required to notify NHSP of any changes in your personal circumstances including changes to your name, address or telephone number or eligibility to work in the UK. If you are employed by another employer, you must inform NHSP of any suspension or disciplinary action taken against you by them. You must also inform NHSP of any referrals or fitness to practice restrictions by your professional bodies. You have a continuing duty to notify NHSP of any relevant change in your circumstances, including the identity of any third party that engages or employs you. As set out in clause 3.2, if you cease to be substantively employed by the Trust for whom you are carrying out Assignments, you are required to notify NHSP immediately in writing.
26.2. Furthermore, if you have a contract of employment with another employer from which you are suspended from duty, you must notify NHSP immediately and NHSP reserves the right to restrict you from carrying out an Assignment and not offer you further Assignments if it is deemed necessary for one of the reasons set out above.
26.3. You are required to wear your photo identity badge while working on an Assignment with NHSP. Failure to wear your photo identity badge while on duty, and/or intentionally or unintentionally allowing your photo identity badge to be used by another individual is a disciplinary offence.
