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• Full Name ^*
• Date of Birth ^*

  Please use format DD/MM/YY.
• Title ^*
  - please select -MrMissMsMrsOther

  Please specify: ^*
• Home Phone ^*
• Personal Mobile ^*
• Personal E-Mail ^*
• Current Address ^*
• Post Code ^*
• Nationality ^*
  - please select -BritishIrishOther

  Please specify: ^*
• Current Employer ^*
• Position ^*

  Note: you must be a practicing APT in order to join the UKDVI APT Team
• Employer Type ^*
  - please select -NHSLocal AuthorityLocumOther

  Please specify: ^*
• Work Phone ^*
• Work Mobile ^*

  If none, write none.
• Work E-Mail ^*
• Work Address ^*
• Postcode ^*
• Qualification Status ^*

  Indicate your highest qualification

  - please select -TrainingCertificate in APTLevel 3 Dip. in APTDiploma in APTLevel 4 Diploma in APTFd. Healthcare Science (Anatomical Pathology)BSc. Healthcare Science (Anatomical Pathology)
• Other Relevant Qualifications ^*

  If none, write none.
• Year Highest Qualification Obtained ^*
• Highest Qualification Certificate ^*

  Please scan and upload certificate.
• AHCS Registration Status ^*
  - please select -NonePendingRegistered
• Registration Number ^*

  If not applicable, write N/A
• AAPT Membership Status ^*
  - please select -NoneStudentAssociateMemberFellow
• Membership Number ^*

  If not applicable, write N/A.
• Other Relevant Memberships ^*

  e.g. BAHID, BIE, etc. (if none, write none).
• Other Relevant Skills ^*

  e.g. sign language, counselling, embalming, etc. (if none, write none).
• Previous DVI Experience ^*

  e.g. deployments, exercises, training, etc.
• DVI Foundation Training Complete ^*
  Yes No
• Passport Number
• Expiry Date ^*

  Please use format DD/MM/YY.
• Able to Deploy Overseas ^*
  Yes No
• Reason ^*

  If no selected above. If yes selected, write N/A.
• Hep. A Immunised ^*

  Note: it is the responsibility of Team Members to keep their Immunisation status current.

  Yes No
• Hep. B Immunised ^*

  Note: it is the responsibility of Team Members to keep their Immunisation status current.

  Yes No
• Typhoid Fever Immunised ^*

  Note: it is the responsibility of Team Members to keep their Immunisation status current.

  Yes No
• Meningococcal Meningitis Immunised ^*

  Note: it is the responsibility of Team Members to keep their Immunisation status current.

  Yes No
• Dip. / Tet. / Polio Immunised ^*

  Note: it is the responsibility of Team Members to keep their Immunisation status current.

  Yes No
• Yellow Fever Immunised ^*

  Note: it is the responsibility of Team Members to keep their Immunisation status current.

  Yes No
• Rabies Immunised ^*

  Note: it is the responsibility of Team Members to keep their Immunisation status current.

  Yes No
• TB Immunised ^*

  Note: it is the responsibility of Team Members to keep their Immunisation status current.

  Yes No
• Influenza Immunised ^*

  Note: it is the responsibility of Team Members to keep their Immunisation status current.

  Yes No
• Emergency Contact Info. ^*

  Include name, relationship, home phone, mobile phone.
• Employer Permission to Deploy ^*
  - please select -YesNoSubject to department workloadOther

  Please specify: ^*
• Photograph ^*

  Please upload a professional photograph of yourself.
• Declaration ^*
  I confirm that I am a practicing APT, and that I am not under suspension or investigation (should this happen, it must be reported to a Team Manager immediately I confirm that I agree to partake in training and exercises related to my membership of the UKDVI APT Team I agree to abide by the UKDVI APT Team code of conduct