Application Form for Membership of the Performance Assessment Model Refinement Working Group

Please ensure all relevant areas of the application have been completed and continue on additional sheets if necessary.

YOUR ANSWERS TO THE QUESTIONS BELOW SHOULD GIVE EXAMPLES, DRAW ON YOUR OWN EXPERIENCE AND BE DIRECTLY RELEVANT TO THE MEDICAL COUNCIL Committee, sub-committee, working group and panel ROLE.

Personal and general details:

1.1SURNAME:

1.2FIRST NAME:

1.3OTHER INITIALS:

1.4TITLE (DR/MR/MRS/MS/PROF etc):

1.5DATE OF BIRTH:

1.6PREFERRED ADDRESS FOR CORRESPONDENCE FOR THE APPLICATION PROCESS:

1.7DAYTIME TELEPHONE NUMBER:MOBILE NUMBER:

1.8EMAIL ADDRESS FOR CORRESPONDENCE FOR THE APPLICATION PROCESS:

Please confirm this is a secure email address for us to contact you by: YES NO

Competencies and Skills

It is important that Committee, Sub-Committee. Working Group and Panel members are appointed with the necessary competencies and abilities to work together to achieve the stated objectives of the Council, namely the protection of the public in their interactions with the profession.

In accordance with the Code of Practice for the Governance of State Bodies, the Council is collectively responsible for promoting the success of the Medical Council byleading and directing its activities. It should provide strategic guidance to the Executive, and monitor the activities and effectiveness of management. Committee members should act on a fully informed basis, in good faith, with due diligence andcare, and in the best interest of the Medical Council.

Specific expertise

The Medical Council would invite those with expertise in public interest, patient safety and advocacy, ethics, corporate governance, finance, risk management, human resource management,regulatory procedures and law.

Specific expert areas- please see the expert areas outlined in the paragraph above and identify which are applicable to you.

Corporate Governance

General Competencies

  • Ability to focus onthe wider perspective and long term implications of decisions
  • Ability to make informed decisions
  • Integrity in both personal and business dealings
  • Adheres to organisational policies and procedures

Equality & Diversity

  • Promotes and appreciates the principles of diversity, considering its principles in the decision making process
  • Is consistent and fair in treatment of others

Please outline your knowledge and experience of good corporate practices, reflecting the competencies outlined above:

Analytical & Strategic Management

Analytical Competencies

  • Ability to think critically and challenge proposals
  • Understands issues from different perspectives
  • Asks for and uses information to make informed judgements/assessments
  • Ability to identify and appropriately manage conflicts of interests.

Strategic Competencies

  • Ability to recognise organisational opportunities and threats
  • Ability to recognise wider economic and societal changes that have an impact on organisations
  • Aware of change and the need for change
  • Understands and practically reflects organisational values

Please outline knowledge and experience of working in an analytical and strategic management capacity, reflecting the competencies outlined above.

Team Working

Character Competencies

  • Creates space for and respects the contribution of others
  • Can be objective at all times about what is best for the organisation
  • Act in an independent and unbiased manner at all times
  • Avoids personal issues
  • Creates and maintains the professional image of the Council
  • Is committed to contributing to all aspects of the Council remit where appropriate

Team Intelligence

  • Supports the Council’s aims and goals while respecting the roles of others
  • Challenges freely and constructively, compromising when appropriate
  • Respects the authority of the Chair
  • Recognises value of inputs by and knowledge base of the Executive Team

Please outline your track record of working with teams and/or on committees (either professional or voluntary), reflecting the competencies outlined above.

Organisational

Communication Competencies

  • Ability to articulate thoughts, opinions, rationale and views in a clear, concise and logical manner
  • Is flexible and willing to change stances when necessary or appropriate
  • Has the ability to listen, analyse and understand key points
  • Ability to interact with other Council members in a group setting, both contributing to and valuing the contribution of all members
  • Ability to adhere to the Medical Council’s communication policies.

Knowledge Competencies

  • Understands responsibilities as a Committee member
  • Understands the key performance indicators of the organisation
  • Awareness of the legal, accounting and regulatory requirement affecting the organisation

Please outline your knowledge and experience of organisational processes, reflecting the competencies outlined above:

Statement of suitability

A short (i.e. no more than 500 words) statement of suitability outlining why you wish to be considered for a position on a Medical CouncilCommittee and the details of the specific committee/s, groups/s and /or panel/s you wish to join:

Membership of Councils, Committees, Panels or Boards

Please list any Councils, Committees, Panels or Boards you have sat on, either in a professional or voluntary capacity, where you have gained experience relevant to the competencies as set out above. Committees which receive and consider papers and determine courses of action or develop a report based on evidence are of particular interest.

Name of Committee / Your role / Dates
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I DECLARE THAT THE INFORMATION I HAVE GIVEN IS, TO THE BEST OF MY KNOWLEDGE AND BELIEF, TRUE AND COMPLETE. I UNDERSTAND THAT MY APPLICATION MAY BE REJECTED OR, IF I HAVE BEEN APPOINTED, THAT I MAY BE DISMISSED FOR WITHHOLDING RELEVANT DETAILS OR GIVING FALSE INFORMATION.

Signed
Date

Thank you for completing this application form and for your interest in the Medical Council.

PLEASE RETURN THIS SIGNED FORM (ACCOMPANIED BY AN UP TO DATE CURRICULUM VITATE ) TO:

Michelle Navan

Performance Assessment Case Coordinator

Medical Council

Kingram House

Kingram Place

Dublin 2

DO2 XY88

Or email to: