NATIONAL HEALTH SERVICEGP21C(rev.02.18)
APPLICATION FOR A VOCATIONAL TRAINING NUMBER
Please complete form and send to:
The Dental Vocational Training Secretariat
NHS Education for Scotland
Floor 2
102 West Port
Edinburgh
EH39DN
E-mail:
NOTES
A faxed copy of this GP21C application form is unacceptable.
If you require more space, please use a separate sheet of paper and attach it to the form.
Please submit original documents if possible.
PART 1 PERSONAL DETAILS
Surname ...... Nationality......
Other names ...... Date of UK registration as a dentist ......
Preferred title(Mr/Mrs/Ms/Dr/etc) ...... GDC registration number......
Private Address ...... Qualification which entitles you to be
registered as a dentist ......
......
University and country where qualification was gained
......
Postcode ...... Date of gaining qualification......
E-mail address ……………………………………. Daytime telephone number (including code)………..…
...... /mobile ......
PART 2 DECLARATION
Completion of this part of the form shows that you have applied to join the dental list of an NHS Board/PCT and indicates the grounds on which you are applying for a vocational training number.
I have applied on ...... ……….(enter date) to be included in the dental list of
NHS ...... (enter name of NHS Board)
I will be working in a General Dental Practice e OR an Orthodontic Practice (please tick one box only)
Name and address of practice......
...... Postcode......
A.I have completed vocational training which commenced on or
after1st September2018YESNO
VT YEAR......
NOTE:If VT was completed more than 5 years ago, or outside Scotland, please enclose copy of
certificate and copy of curriculum vitae.
B.I am exempt from the requirement to complete vocational training because:
I am an EC National holding a recognised European Diploma (Other than UK)
Please enclose a certified translation of your original diplomaYESNO
OR
My name has been included in the dental list of......
NHSB/HA/FHSA/HC* within the period of five years immediately before myYESNO
application to be included in a dental list
My last list/performer number was ......
(*contact telephone number for verification:………………………………………………….)
OR
I have completed a course of vocational training under a voluntary schemeYESNO
Please enclose your original training certificate
OR
I have previously practised in primary dental care for at least four years in
the aggregate in either the Community Dental Service or the Armed Forces
of the Crown, and have practised in primary dental care for not less than
four months in full-time employment (or part-time employment of equivalent
duration) within the period of four years immediately before my application
to be included in a dental list.
Please enclose a letter from your employer confirming your experienceYESNO
C.I consider that I have acquired experience and/or training which should be
regarded as equivalent to vocational trainingYESNO
Please submit full details including your CV, postgraduate education and written references (see Guidance Notes for further information)
This is a re-application YESNOIf ‘Yes’, I applied previously in ………/………(month/year)
PART 3 ENCLOSURES AND SIGNATURE
I enclose the following documents to support my application:
......
Signed ...... Date......
Please remember that this vocational training number application form cannot be processed if you have notsubmitted an application to a NHS Board(form GP21) to join its dental list.
/ Data Protection: NES uses the personal data you provide for purposes associated with our responsibilities for health workforce development, including the administration of courses, monitoring training programmes and circulating information relating to relevant development opportunities. For more information see Personal data will be retained in line with our records retention policies. We will not share your data with third parties.