Paediatric Training

 

Central Scotland

 

Training Centre

 

 

 

Central Scotland Training Centre
Instructor Registration

(All * fields are mandatory)

 


Full name (this is how you wish your name to appear on your course certificate)

Title * Please select an item.
Forename(s) * A value is required.
Surname * A value is required.


Name that you are known/called by (this will go on your ID Badge)

Name * A value is required.


Personal Details

Address Line 1 * A value is required.
Address Line 2
Address Line 3
Town / City * A value is required.
Postcode * A value is required.
Country * A value is required.
Mobile Number * A value is required.
Email * A value is required.Invalid format.
Special Physical Needs * [Type No, if you have no special needs] A value is required.
Special Dietary Needs * [i.e. Gluten free, Any allergy, Halal, No Beef, No Pork etc.
Type No, if you have no special dietary
needs]
A value is required.


Professional Details

Job Title * Please select an item.
Speciality * Please select an item.
GMC/NMC/HPC Number
(UK applicants only) *
[Type N/A if you are not UK Applicant]
A value is required.
Which NHS Health Board or NHS Trust do you work in?*
Please make a selection.
Name of Hospital or Institution * A value is required.
Address of Hospital or Institution *
Address Line 1* A value is required.
Address Line 2
Address Line 3
Town/City* A value is required.
Country* A value is required.
Postcode* A value is required.


Username/Password (For Member Login)

Username * [This must contain a combination of letters and at least one number (0-9)] A value is required.
Password * [Minimum character 8, maximum 12, No special character (&,!,$,%,...) please] A value is required.Minimum number of characters not met.Exceeded maximum number of characters.


Photo Upload (For Course Administration)

Please upload a recent photo of yourself. *
[Please ensure that the photo you are uploading is named in the following format: 'firstname_surname', e.g. if your name is David Jones then name your photo file as David_Jones.jpg, before uploading it. We accept photo files of any of the following formats: gif, jpeg, jpg, pjpeg, x-png, png.]


Instructor Details

Please select your current instructor status. * Please select an item.
When are you next due to recertify your instructor status? *
Date Month Year
Please select an item. Please select an item. A value is required.
Please choose the course(s) that you wish to teach next?
APLS 04 Apr-05 Apr 2020
APLS 02 May-03 May 2020
APLS 30 May-31 May 2020
APLS 27 June-28 June 2020
APLS 25 July-26 July 2020
APLS 22 Aug-23 Aug 2020
APLS 19 Sep-20 Sep 2020
APLS 17 Oct-18 Oct 2020
APLS 14 Nov-15 Nov 2020
APLS 05 Dec-06 Dec 2020
PHPLS 04 Apr-05 Apr 2020
PHPLS 02 May-03 May 2020
PHPLS 30 May-31 May 2020
PHPLS 27 June-28 June 2020
PHPLS 25 July-26 July 2020
PHPLS 19 Sep-20 Sep 2020
PHPLS 17 Oct-18 Oct 2020
PHPLS 14 Nov-15 Nov 2020
PHPLS 05 Dec-06 Dec 2020
GIC 16 May-17 May 2020
GIC 08 Aug-09 Aug 2020
GIC 05 Sep-06 Sep 2020
GIC 31 Oct-01 Nov 2020
GIC 12 Dec-13 Dec 2020
ALS 04 April-05 April 2020
ALS 18 April-19 April 2020
ALS 02 May-03 May 2020
ALS 13 June-14 June 2020
ALS 18 July-19 July 2020
ALS 26 Sep-27 Sep 2020
ALS 21 Nov-22 Nov 2020
e-ALS 02 April 2020
e-ALS 03 April 2020
e-ALS 30 April 2020
e-ALS 01 May 2020
e-ALS 28 May 2020
e-ALS 29 May 2020
e-ALS 25 June 2020
e-ALS 26 June 2020
e-ALS 23 July 2020
e-ALS 24 July 2020
e-ALS 20 August 2020
e-ALS 21 August 2020
e-ALS 17 September 2020
e-ALS 18 September 2020
e-ALS 15 October 2020
e-ALS 03 December 2020
e-ALS 04 December 2020


Instructor Training History

(Please type N/A in the fields that are not applicable for you. For example if you are IC1 and haven't done IC2 then please write N/A in the fields relevant to IC2 and FI)

Status/Course Details Course Date (dd/mm/yyyy) Course Centre
Instructor Potential (IP) * Please state when & where you were nominated for IP status. A value is required. A value is required.
Generic Instructor Course (GIC) * Please state when/where you undertook GIC training. A value is required. A value is required.
Instructor Candidate Level 1 (IC1) * Please state when/where you did your first IC course A value is required. A value is required.
Instructor Candidate Level 2 (IC2) * Please state when/where you did your second IC course (If you were exempt, simply write 'Exempt') A value is required. A value is required.
Full Instructor (FI) * Please state when/where you taught on a course as a FI for the first time. A value is required. A value is required.

 


Instructor Teaching History

Starting from the most recent, please list all the courses that you have taught as a full instructor, director candidate or course director. If you have been teaching APLS for more than 4 years, please only list the last four years of courses you have taught on.

Press 'Add line' button to add new line for the second last course and then for third course. Please write N/A if you don't have any teaching history.

Course Date (Start)
(Start from the most recent to the oldest)
Course Date (End) Course Centre
A value is required. A value is required. A value is required.

 

 

Other Teaching Experience

Type of Course

Course Title

Instructor Status

Paediatrics & Neonatology *

EPLS

Please select an item.

APLS

Please select an item.

PHPLS

Please select an item.

pILS

Please select an item.

PLS

Please select an item.

EMNCH

Please select an item.

ECHT

Please select an item.

VHW

Please select an item.

NLS

Please select an item.

NCC

Please select an item.

Obstetrics *

MOET

Please select an item.

POET

Please select an item.

TBA

Please select an item.

Acute Medicine/Surgery *

ALS

Please select an item.

ILS

Please select an item.

MedicALS

Please select an item.

ATLS

Please select an item.

ETC

Please select an item.

Incident Management *

MIMMS

Please select an item.

HMIMMS

Please select an item.

HAZIMMS

Please select an item.

Child Protection *

CPRR

Please select an item.

CPIP

Please select an item.

Transfer Medicine *

STaR

Please select an item.

PaNSTaR

Please select an item.

Teaching Skills *

GIC

Please select an item.

HF

Please select an item.

 

Accomodation

Do you need an accomodation for the first course that you wish to teach on? Please select an appropriate option for you.

Please select an item.

If you require us to book accomodation for you, please state the dates of your check-in and check-out.
Check-in date
Check-out date

 

Parking

Do you want to arrange car parking?

Please select an item.

If you require us to book parking for you, please state your car registration number and the dates of your car check-in and check-out.
Car Registration no.
Car Check-in date
Car Check-out date

 

 

Professional Time

Are you teaching on this course during your personal time or professional time? Please select an item.
Please check all the details and click on the check box before submitting the application form.* Please make a selection.