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*Name:
Current Occupation:
Residential Address:
Current Hospital/NHS Trust and address:
*Email Address:
*Tel No.
Mobile No
Previous Hospital/NHS Trust and Address worked in if less than a year at current hospital/NHS Trust:
Date Qualified:
(full disclosure of your education and other associated qualifications will be required if your registration is successful)
Relevant surgical assisting qualifications :

Number of hours available per week:

(full disclosure of your work experience will be required if your registration is successful)
Do you have professional indemnity insurance in place:
Yes No
If yes please provide details:
Name of insurers:
Renewal Date :
(Documentary evidence will be required if your registration is successful)
If no, candidates will be required to have insurance in place before registering with FAL. Information available on request.

1. Minimum criteria entry: (a) Surgical Practitioner Part 1 (SP1/SCP1); or (b) Advanced Scrub Practitioner (ASP) (based on the NAASP syllabuses); or (c) ENB N77

2. Candidates will be required to provide documentation and verification under the attached Process Requirements

to email this registration click send

to fax click [print] and send to: 01494 868278


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