FELLOWSHIP APPLICATION FORM

Improving Global Health through Leadership Development

International Placement – 6 months duration

Note to Candidates – this recruitment is a two-stage process. The first stage will be recruitment onto the programme subject to references. Once recruitment to the programme is agreed, the second stage will be to arrange the most appropriate placement opportunity. This will be dependent on the needs of our Overseas Partners and on individual Fellow’s experience and skills. Acceptance onto the scheme does not necessarily guarantee a placement overseas.

During the 6 month duration, a stipend is paid per calendar month to cover the essential living costs for each particular placement site. This will be paid for the period of the placement and the amount will vary per placement site (range is £800 to no more than £1,000).

Title: / First Name: / Surname:
Correspondence Address:
Post Code:
Contact Telephone Number: / Email:
(This will be for all future correspondence) / GMC, HPC or NMC Number:
Profession:
Job Title and specialty area: / AfC Grade OR Year of Training if Doctor/Dentist in a training post OR Title of Post if any other Doctor/Dentist / Name of Employer:
(Hospital/Surgery/Trust/Practice, please state if working as a Locum)
All placements are for 6 months. Please indicate site/country in order of preference from 1 to 3 and availability.
1.  2. 3.
Dates available from / to:
When on placement, you may be required to drive a car or motorcycle, or ride a bicycle. Are you able to:
Drive a car Ride a motorcycle Ride a bicycle
For Doctors in training posts – agreement of availability for OOPE for the dates above confirmed by:
·  Educational Supervisor/GP Trainer
Signature ………………………………………………………………………......
Date ……………………………………………………………………………......
·  Programme Director
Signature ………………………………………………………………………......
Date ……………………………………………………………………………......
How did you hear about the IGH programme?
Leadership Ambition and Experience:
Up to 400 words
(Please provide details of any experience you may have in leading others including experience outside of work. You may want to refer to the following framework to help evaluate the experience you have)
http://www.leadershipacademy.nhs.uk/discover/leadershipmodel/
Motivation and Benefits:
Up to 400 words
(State what interests you most about the Improving Global Health through Leadership Development Fellowship in terms of your career plans and what you hope to gain from participating in it in terms of your personal and professional development. Please also include how you believe your participation in the scheme will benefit your work in the NHS on your return).
Previous relevant experience.
Up to 400 words
(Please provide details of any experience you have of working with people from a different culture or community other than your own, and describe what you learned from it. Please also tell us about any overseas experience (work and/or travel) you have had and what you gained from that experience also.
Before submitting this form, please ensure that you have read the information on the website and in particular the FAQs.
References:
(Please provide the contact details for two referees who can provide a reference for you in the context of this project, one of whom must be your current employer/supervisor. Referees will be approached after interview.)
Referees:
Name ……………………………………………………………………….
Position …………………………………………………………………….
Address ……………………………………………………………………
Telephone number ………………………………………………………..
Email ………………………………………………………………………..
Name ……………………………………………………………………….
Position …………………………………………………………………….
Address …………………………………………………………………….
Telephone number ………………………………………………………..
Email ……………………………………………………………………….
·  Please return this form together with a current CV by email to the address below by 9am on Tuesday 6th March 2018. Please email both as pdf documents saved in your name followed by ‘CV’ or ‘Application’ as applicable.
·  You will be notified by Friday 16th March 2018 if you have been shortlisted for interview.
·  Interviews will be held the morning of Friday 23rd March 2018 at Health Education Wessex, Southern House, Otterbourne, SO21 2RU. Alternatively, interviews can be held via Skype. Interviews are approximately 35 minutes.
·  If you are successful at interview and subject to references, you will be required to attend a two-day induction on Thursday 24th and Friday 25th May 2018 in Winchester.
·  NB: A contribution of up to £50 for travel expenses to attend an interview will be considered for those whose return journey is greater than 100 miles.
·  Email:

Signature …………………………………….…………… Date …………………………………………..

Note to Candidates – this recruitment is a two-stage process. The first stage will be recruitment onto the programme subject to references. Once recruitment to the programme is agreed, the second stage will be to arrange the most appropriate placement opportunity. This will be dependent on the needs of our Overseas Partners and on individual Fellow’s experience, skills and availability. Acceptance onto the scheme does not necessarily guarantee a placement overseas.

IGH Recruitment – March 2018

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