Application to the Swedish Register of Toxicologists1 ( 3 )
Instructions:
Please fill in and send electronically gether with appendices (as specified in section 4 below)
The last page (with Section 5) of this application must be printed, signed and scanned before submitting.
Please write ”ERT” in the subject line of the mail.
Payment of SEK 1000 (SFT members) or SEK1200 (non-SFT members) must be made to Plusgiro 65 89 95-6.Please write ”ERT” and your name in the message section. Your application will not be considered if the payment has not been received.
Deadline for submitting this application and for paying the fee is February28, 2018.
APPLICATION TO THE SWEDISH REGISTER OF TOXICOLOGISTS
1. Personal information
Surname:
First name:
Date of birth:
Home address:
Work address:
Telephone:
E-mail address:
2. Education and theoretical training (date, university, major subject):
(sections A2 and A3 in the Swedish Guidelines for Registration)
Basic university degrees (Master and/or Bachelor degree, date, university, major subject):
Ph.D. degree (degree, date, university):
Subject of thesis:
Professorship (docent/professor) in toxicology (title/area, start date, university and faculty):
There are two alternative routes to meet the theoretical toxicological training requirements:
Route 1: Relevant education pertaining to core/elective topics in section B of the guidelines (specify area of toxicology, study weeks/credits, test date, organizer). It is important to specify and describe the training for each topic (B1, B2…). Please refer to Annex 1 of the European Registration Guidelines for details about requirements.
Route 2:Alternatively, theoretical training in toxicology can be acquired by long-standing experience and on the job training(section A3.2 in the Swedish Guidelines for Registration)
Describe training pertaining to core/elective topics in section B of the guidelines (specify area of toxicology). It is important to specify and describe the training for each topic (B1, B2…). Please refer to Annex 1 of the European Registration Guidelines for details about requirements.Enclose relevant documentation.
3. Practical experience in toxicology (working as a toxicologist):
(sections A4 and C in the Swedish Guidelines for Registration)
List names of employers, time and nature of the work (title, research, regulatory, etc):
Short description on working experience in toxicology. Describe practical awareness pertaining to the topics listed in section C of the guidelines. Experience must be documented by at least five confidential reports, assessments, or publications:
4. List of appendices
(Curriculum vitae, degree/course certificates,list of publications and/or reports, etc). NB. Your application may be delayed or not approved if these documents are not enclosed with the application.
5. Signature
I attest that the information included in this application is correct.
Date:
Signature: