WORK EXPERIENCE

Shadowing a Consultant 2017

Expression of Interest Form

Thank you for your expression of interest regarding work experience opportunities within the Heart of England NHS Foundation Trust.

Please complete all sections of this form to progress your application.

This placement should give you an insight into what being a doctor will involve and will include joining consultant ward rounds and spending time in outpatients. You will also have the opportunity to speak to junior doctors and other members of the multidisciplinery team

Date Applied
Name / Male/Female
Date of Birth / Age:
Home Address
Email Address
Home Telephone Number
Mobile Number
Emergency contact details / Name:
Telephone number:
Address:
Name and Address of Educational Establishment (School, College, University etc)
School Year
Name of School Contact
School e-mail address
Specific area of Interest?
Site: Heartlands Hospital / Solihull Hospital
Required Dates of Placement / From: To:
Duration of Placement / One week
Other placements within the Trust?
What do you hope to do when leaving school/university?
How did you find out about us?

Student Application: Employer Summary

A level subjects

Subject / Grade

GCSE Grades

Subject / Grade

School/College/Employer Reference (any offers of work experience are conditional on a full supporting referencefrom your school/college tutor or employer)

Teacher/Tutor/Employer Name:

Contact E-mail Address:

Reference:

Student Application:

Assessment Questions

1. Why do you feel you should be offered this opportunity? Please give details any research undertaken, work experience, other contact with professionals, etc.

2. Please detail how you spend the majority of your time outside of school/college, including any positions of responsibility, paid employment, volunteering, hobbies etc.

3. How have you developed your communication and interpersonal skills in the last two years?

4. Please give an example of when you have worked successfully in a team, explaining clearly what your role within the team was.

5. Please give an example of when you have changed your behaviour in response to criticism

6. What do you think is the biggest problem facing the world today?

7. “You are a product of your environment”. Please explain why you either agree or disagree with this statement.

8. If you could have dinner with anyone past or present, who would it be and why?