| Current Hospital/NHS Trust and address: |
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| Previous Hospital/NHS Trust and Address worked in if less than a year at current hospital/NHS Trust: |
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| (full disclosure of your education and other associated qualifications will be required if your registration is successful) |
| Relevant surgical assisting qualifications : |
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Number of hours available per week: |
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| (full disclosure of your work experience will be required if your registration is successful) |
Do you have professional indemnity insurance in place:
Yes
No
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| If yes please provide details: |
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| (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 |