Medical Training Initiative (MTI) application form

Please ensure you have completed all sections of this form. This form should only be used if you have secured an MTI training post. Please be aware, the College will not start processing your application until you have submitted your CV using the template provided and ALL the required supporting documents. If you have any questions or need assistance, please contact our International Team.

Personal details

First Names *

Last Name *

Date of Birth (dd/mm/yyyy) *

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Home address: *

Postcode *

Contact number *

Email address *

Specialty *

Microbiology Virology Chemical Pathology Haematology Histopathology

Primary Medical Qualification *

Postgraduate Qualification *

EMPLOYMENT STATUS AND REFEREES

Current Job title *

Current Hospital *

Employment Dates:
 

From *

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To *

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Current Supervisor - (Referee 1)
 

Job Title *

Full name

Dates *

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Email *

Referee 2:
 

Full name *

Job Title *

Dates

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Email *

TRUST ROUTE POST DETAILS

Title of Post *

Trust *

Deanery

East Midlands East of England Kent, Surrey, Sussex London (North) London (South) North East North West Northern Ireland Scotland South West Thames Valley Wales West Midlands Yorkshire and the Humber

Duration of Post *

12 months 24 months

Medical Personnel

Name *

Email Address

Phone number *

Educational Supervisor

Name *

Email Address *

Phone number *

Funding - Please enter details on where your funding will come from *

Funding amount per annum *

Submit