Regulation 8(1)
1. An application shall contain the following information:–
(a)full name, sex, date of birth and private address and telephone number;
(b)medical qualifications and the institution which awarded them;
(c)where appropriate evidence concerning the applicant’s qualifications and experience in accordance with the National Health Service (Vocational Training for General Medical Practice) (Scotland) Regulations 1998(1);
(d)professional registration number in the Medical Register and date of first registration;
(e)details of professional experience (including start and finish dates for each appointment together with explanation of gaps between appointments) divided into–
(i)general practice experience;
(ii)hospital appointments; and
(iii)other (including obstetric) experience,
together with additional supporting particulars including reasons for dismissal from any post;
(f)details of any medical list (or equivalent or similar list in any country outside Scotland) from which the applicant has been removed or suspended or to which admission was refused together with reasons for removal, suspension or refusal;
(g)name and addresses of two referees who are willing to provide clinical references relating to two recent posts as a medical practitioner which lasted at least 3 months without a significant break and which may include a current post, or, where this is not possible a full explanation and an alternative referee or referees;
(h)such other information which the Board may reasonably require in order to determine the application; and
(i)whether in assisting in the provision of contraceptive services, intra uterine devices will be fitted.
2. An application shall contain the following declarations:–
(a)that the applicant’s name is included in the Medical Register;
(b)whether the applicant has been convicted of a criminal offence, bound over or cautioned in the United Kingdom or elsewhere, and if so, as to approximate dates of what the action or proceedings were, or are to be, brought, the nature of that action or proceedings and any outcome;
(c)whether the applicant has been or is currently, subject to any action by any professional body, or by any licensing or regulatory body, in the United Kingdom or elsewhere, and if so, as to approximate dates of what the action or proceedings were, or are to be, brought, the nature of that action or proceedings and any outcome;
(d)whether the applicant has been, or is the subject of proceedings which might result in the applicant being removed or suspended from or refused admission to a medical list (or any equivalent or similar list in England, Wales or Northern Ireland);
(e)that the applicant consents to a request being made to any employer or former employer and any regulatory or other body, wherever they may be, for information relating to any of the matters referred to in this paragraph or paragraph (1);
(f)that in assisting in the provision of contraceptive services the applicant shall be guided by modern authoritative medical opinion and contraceptive practice; and
(g)that the applicant will comply with the National Health Service (General Medical Services Supplementary Lists) (Scotland) Regulations 2003.
S.I. 1998/5.