1. No category

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Application form and
Guidance notes on how to
apply for registration as a
pharmacy technician with
current GPhC approved
qualifications and work
experience
Pharmacy Technician Registration,
General Pharmaceutical Council
129 Lambeth Road, London SE1 7BT
[email protected]
www.pharmacyregulation.org
tel: 0203 365 3400
GPhC Dec 2013
Applicants with the currently approved GPhC qualifications and work experience
This registration guidance should provide you with all the information you need about how to register.
Please read this carefully before contacting the General Pharmaceutical Council (GPhC).
You can submit your application no sooner than 4 weeks before you are due to complete the relevant
work –based experience. For example if you are applying with UK qualifications only (with no overseas
qualification) and you started the 2 years’ work experience on 1 September 2009, the earliest you can
submit your application is during the first week of August 2011.
Please note the application you submit must be complete and include all supporting documents and
qualification certificates correctly certified by a solicitor or a commissioner of oath. Incomplete applications
will be returned to you and where we require additional information this may delay your registration. If you
do submit an application before you complete the relevant work based experience your supervising
pharmacist must complete the additional declaration confirming the date when the period will finish.
Due to Crown Copyright, from the 5th February 2013 the GPhC will not be able accept certified copies of
Birth Certificates from anyone born in the UK. This also applies to certified copies of marriage certificates.
You will now need to provide, with your application, a duplicate birth certificate issued by General Register
Office as proof of your date of birth, and a duplicate marriage certificate issued by General Register Office if
required. This document will not be returned to you and will be held on record by the GPhC.
We strongly advise that you do not provide your original birth & marriage certificates, but instead apply for
a duplicate of the document(s) as they will not be returned to you. If you were born in England or Wales you
should contact the General Registers Office (or General Registers Office for Scotland if you were born in
Scotland), so that you can apply for a duplicate directly from them.
If you were born in the UK you should not be able to obtain a certificated copy of your Birth Certificate and
will not be accepted by the GPhC. If you do supply, a certified copy, it will delay your registration while you
obtain an original General Register Office Birth Certificate as proof of your date of birth. The same will also
apply for marriage certificates.
If you were born outside the UK you should still provide a certified copy as outlined in the registration
guidance notes
Completed forms must be sent to Pharmacy Technician Registration, GPhC, 129 Lambeth Road, London SE1
7BT
The GPhC enters applicants onto the register on the 1st and 15th date of each month. You will not have
access to your registration number until the date that you are due to register (as of 12.01 a.m. on that day).
You can obtain your registration number from the GPhC website by doing a pharmacy technician search and
entering your name.
A few weeks after you have been registered, a letter will arrive confirming your registration. This will
confirm the part of the register in which you have been registered, your name as it appears on the Register,
your registration number, the date of entry on the Register and the period that your entry is valid.
The GPhC does not issue certificates. Your registration number is proof of registration with the GPhC.
GPhC Dec 2013
Applicants with the currently approved GPhC qualifications and work experience
Preparing and completing your application
1.
Read all the guidance carefully.
2.
Complete the application form in BLOCK CAPITALS and mark boxes clearly to answer the
questions.
3.
Check the guidance if you are not sure how to answer a question. Additional guidance documents
are listed below. Contact us if you are still not sure how to answer a question.
4.
Using the Registration application checklist, collect together all your certificates and passport.
See below for alternatives to current passports.
5.
If you are applying and have a non-UK pharmacy qualification as well as the 2 approved UK
qualifications, there are additional documents you will need to send.
6.
Check that all the names on your documents are spelt the same way and any changes in name can
be tracked. If there are variations see below for advice.
7.
Arrange to visit a UK practising solicitor or commissioner of oath to obtain certified photocopies of
the original documents you need to submit.
8.
Arrange for your photograph and section 9 of the form to be signed (your countersigning pharmacist
or pharmacy technician can sign if they have known you for at least 2 years).
9.
Arrange to meet with the pharmacist/pharmacy technician who will countersign your application
form.
10. Before meeting your pharmacist/pharmacy technician, check you have answered all the questions
in the application form. Using the checklist, check you have provided all the necessary copies of
documents.
11. Once you have signed section 7 yourself, your countersigning pharmacist or pharmacy
technician should check your application thoroughly before signing section 8 A of your form.
12. Send your completed application to us as instructed on the checklist.
13. It is important that your application is double checked before sending it to us.
14. If any information or documents are missing we will return your application and your registration will
be delayed. We will charge a £47 administration fee if we have to return applications for missing
information more than once.
GPhC Dec 2013
Applicants with the currently approved GPhC qualifications and work experience
Additional guidance documents and forms
The following documents can be downloaded from our website www.pharmacyregulation.org
Guidance:
Standards of conduct, ethics and performance
Standards for continuing professional development
Criteria for the initial registration as a pharmacy technician
Guidance on registration with the GPhC and Fitness to Practise: This advises how to answer the
questions on fitness to practise.
Good character assessment framework: This lists the areas we will take into consideration when
you have declared a conviction or police caution.
Health assessment framework: This lists all the relevant points we will take into consideration
when you have declared matters concerning your health.
Additional forms:
Something to declare form. To be completed if you have declared a conviction, caution or
health matter.
GPhC Dec 2013
Applicants with the currently approved GPhC qualifications and work experience
Registration application checklist
Application form (including photograph certification)
Payment form
Birth certificate – original copy from applicants born in the UK or certified copy for applicants born
overseas (and/or statutory declaration)
Marriage certificate/s (if you are married) – original copy from applicants born in the UK or certified
copy for applicants born overseas (or statutory declaration)
Certificates for the competency based and knowledge based qualifications and non-UK qualification
(if applicable) – certified copies
Passport – certified copy or alternative documents
Photograph – attached to section 9 of the application form
Stamped self addressed postcard for confirmation that we received your application
If you have a non-UK pharmacist or pharmacy technician qualification and want to use evidence of
this to reduce the 2 year qualifying period of work experience required you must arrange for the
following documents to be sent direct to the GPhC
Academic transcript relating to your qualification. This must be sent to the GPhC by your awarding
institution (college/university)
Evidence that you are registered or otherwise eligible to practise as a pharmacist or pharmacy
technician in the country of your qualification. You must arrange for the regulatory authority or
awarding institution to confirm this direct to the GPhC. If the profession is regulated in your country
of qualification this is normally in the form of a letter of good standing or certificate of current
professional status.
Send your completed forms and other documents to
Pharmacy Technician Registration,
General Pharmaceutical Council
129 Lambeth Road,
London SE1 7BT
We will only accept complete applications. Both declarations (see sections 7 and 8) must be signed and
supporting documents included with your application form.
We will not accept liability for any loss as a result of completed applications not reaching us.
Recorded delivery is recommended.
Keep a copy of your application in case the original does not reach us.
A stamped addressed postcard must be enclosed with your application for us to acknowledge
receipt. Applications can take as long as 4 weeks to process. This can be much longer if you
have disclosed a fitness to practise matter.
GPhC Dec 2013
Applicants with the currently approved GPhC qualifications and work experience
How to complete the application form
Section 1 Personal details
Questions 1.2 and 1.3 Names
The name you register under must be the same as the name you intend to practise under. This will be your
registered name.
If you wish to be registered in a different name from that printed on your birth certificate you must provide either:
An original copy of your marriage certificate or other acceptable documentation (for instance a Deed Poll
or certificate of Civil Partnership), or
A statutory declaration completed in front of a solicitor. A statutory declaration form is provided at the
end of the application pack.
Your name on all the documents you submit must be exactly the same – letter for letter, word for word. If
there are any variations in your name within or between documents you must provide a declaration of those
variations on the Statutory Declaration form, sworn before a solicitor registered and in good standing, with the
Law Society of England and Wales or Scotland who is practising in one of those jurisdictions.
Please tell us if you change your name. If you change your name whilst we are processing your application, you
must notify us in writing and send a certified photocopy of the relevant document (for instance a statutory
declaration or original marriage certificate). If you change your name after you are registered, you must notify us
in writing within one month of the date of change with a certified copy of the relevant document.
Question 1.5 and 1.6 Your address
Your registered address must be the address where you live, as this is the address we will use when we write to
you.
We will not publish this address on the publicly available Register. Please provide us with an e-mail address. We
will contact you by e-mail if we require additional information or documents.
You must keep your contact details up to date. If you change your home or e-mail address you must notify us
as soon as possible. If you fail to keep your contact details up to date and we cannot contact you for clarification
this will delay your application.
GPhC Dec 2013
Applicants with the currently approved GPhC qualifications and work experience
Section 2 Application type
Please tell us what type of applicant you are by ticking the appropriate box on the application form.
Section 3 Previous applications and Registration with other bodies
Question 3.1 Previous applications
You must tell us if you have previously:
registered with the Royal Pharmaceutical Society of Great Britain (RPSGB) or the GPhC in the past as a
pharmacist or pharmacy technician
applied for registration with the RPSGB or GPhC as a pharmacist or pharmacy technician
undertaken or applied to RPSGB or GPhC for pre-registration training.
If any of the above applies, you must also tell us:
the date of your application
the type of application (for instance, was it made through transitional provisions, as an international
application or were you applying to register as a pharmacist)
any previous registration or pre-registration numbers or application numbers you may have had
any other information you think is relevant (for instance, if you began an application but then
withdrew).
Questions 3.2
You must tell us if you are, or have been, registered with any other regulatory bodies either in the UK or
overseas. If you are registered with more than one body please provide details on a separate sheet. If you are
relying on your non-UK qualification for registration you must arrange for a letter of confirming your
registration status and/or eligibility to practise to be sent directly to us by the issuing authority.
Section 4 Fitness to Practise
We define a ‘conviction’ as a finding, in criminal proceedings in the UK (or elsewhere), that a person has committed
the offence alleged. You do not need to include road traffic offences where you were offered the option of paying
a fixed penalty. This is even if you refused the option of paying the fixed penalty and were convicted of the offence
by a court.
You must tell us if you have been involved in any legal or disciplinary proceedings including any that have
resulted in a caution or if you have any problems with your physical or mental health that may impair your ability
to practise. Failure to do so may result in misconduct allegations at a later stage.
You must tick either yes or no to questions 4.1 to 4.7.
If you have answered yes to any of the questions you must complete the Something to declare form.
GPhC Dec 2013
Applicants with the currently approved GPhC qualifications and work experience
Section 5 Education and training
Approved UK qualifications
You must hold:
One of the competency qualifications
and
One of the knowledge qualifications
The eligible qualifications are listed in Annex A of the Criteria for initial registration as a pharmacy
technician.
Only include the UK qualifications listed in Annex A which you hold and not pharmacy/dispensing assistant
or medicines counter assistant qualifications.
For each of the qualifications, write the exact title of the qualification, the date you started your course and the
date you were awarded your qualification.
If you hold a non-UK pharmacy qualification, in addition to the 2 approved UK qualifications, and wish to rely on
this to reduce the 2-year qualifying period of work experience you must tell us:
the title of this qualification,
the name of the awarding institution and
the country where your qualification was obtained.
GPhC Dec 2013
Applicants with the currently approved GPhC qualifications and work experience
Section 6 Qualifying periods of work experience
You need to provide evidence of having completed a minimum of two years relevant work-based experience in the
UK under the supervision, direction or guidance of a pharmacist to whom you have been directly accountable for not
less than 14 hours per week. Within this 2 year period there must be at least 1260 hours of work experience in total
and there must be a minimum of 315 hours in each of the two years. This duration in hours excludes sickness
absence, maternity/paternity leave and holidays. (Please see section 7 of the GPhC Criteria for initial registration as a
pharmacy technician on the GPhC’s website for further information).
You can include work experience, during your pharmacy technician courses and up to 3 months before the start of
the course, provided that during this time you have been working and carrying out the role of a pre-registration
trainee pharmacy technician in the United Kingdom, Isle of Man or Channel Islands under the supervision, direction
or guidance of a pharmacist to whom you have been directly accountable. This is because within 3 months of
commencing contracted relevant work experience as a pre-registration trainee pharmacy technician you must
commence or register for one of the two required qualifications listed above.
If there are gaps in your work experience, e.g. due to maternity leave, you will need to give a brief explanation in a
covering letter.
If there are variations in your hours over the two years, please provide details on a separate sheet.
If you have told us that, you hold a non- UK pharmacy qualification and that you have completed
One of the competency based qualifications and
One of the knowledge based qualifications (listed in Annex A of the Criteria for initial registration as a
pharmacy technician)
You are not required to complete the full 2 years relevant work experience in the UK if you provide evidence:
that you have relevant work-based experience in the UK as a pre-registration trainee pharmacy
technician under the supervision, direction or guidance of a pharmacist to whom you have been directly
accountable for not less than 14 hours per week whilst you have been completing the two approved UK
qualifications. You can include work experience, during your pharmacy technician courses and up to 3
months before the start of the course, provided that during this time you have been working and
carrying out the role of a pre-registration trainee pharmacy technician in the United Kingdom, Isle of
Man or Channel Islands under the supervision, direction or guidance of a pharmacist to whom you have
been directly accountable; and
that you hold a non-UK pharmacist or pharmacy technician qualification. You must arrange for your
awarding institution to send direct to the GPhC the academic transcript relating to your qualification;
and
that you are registered or otherwise eligible to practise as a pharmacist or pharmacy technician in the
country of your qualification. You must arrange for the regulatory authority or awarding institution to
confirm this direct to the GPhC. If the profession is regulated in your country of qualification this is
normally in the form of a letter of good standing or certificate of current professional status.
GPhC Dec 2013
Applicants with the currently approved GPhC qualifications and work experience
Section 7 Declaration by applicant
You must sign and date the declaration. The GPhC register is divided into parts. Part 2 is for registration as a
pharmacy technician.
Fraudulently procuring an entry in the pharmacy technicians’ register will be treated as misconduct and may
result in removal from the Register.
Section 8 A Declaration by countersigning pharmacist or pharmacy technician
This section must be completed by a practising pharmacist/pharmacy technician with current UK registration who
is in good standing.
The pharmacist’s/pharmacy technician’s registration number must be provided so we can verify their details.
The countersignatory is asked to declare that to the best of their knowledge the information given in the
application and in any supporting information is true and accurate, and relates to you.
If you are sending your application in advance of having completed the relevant period of work experience
Section 8B must be completed by the pharmacist under whose supervision, direction or guidance you
have been working in the UK and to whom you have been directly accountable.
Section 9 Photograph certification guidance
You must provide one recent passport sized photograph. This must be signed on the back by an appropriate
official. The photograph must be attached to the photograph certification page of your application form.
The person who signs the photograph (the counter signatory):
Must be a professional person, or a person of standing in the community. Examples include a
pharmacist, registered pharmacy technician, a UK registered solicitor or a licensed Medical
Practitioner. If you have any questions about who is an appropriate official contact us.
Must have known you for at least 2 years
Must not be related to you by birth or marriage. Neither should they be in a personal relationship with
you e.g. husband and wife, nor live at your address.
Must write on the back of the photograph the words ‘I certify that this is a true likeness of (give full
name of the applicant)’ They must also sign and date the back of the photograph.
They must also complete the photograph certification page of the application form giving their full name,
occupation and sign and date the form.
GPhC Dec 2013
Applicants with the currently approved GPhC qualifications and work experience
Requirements for the photograph
The photograph must be:
Taken within the last month
In colour
Against off-white, cream or light grey plain background so your features are clearly
distinguishable
Printed on low-gloss, plain-white photo-quality paper
Undamaged, for example, by creases from paperclips
Of you
on your own
In sharp focus and clear
Have a strong definition between the face and background
The photograph must show:
No shadows
You facing forwards, looking straight towards the camera
A neutral expression, with your mouth closed (no obvious grinning, frowning or raised eyebrows)
Your eyes open and clearly visible (no sunglasses or heavily tinted glasses and no hair across your
eyes)
No reflection or glare on your glasses, and the frames should not cover your eyes
Your full head, without any head covering, unless it is worn for religious beliefs or medical reasons
Nothing covering your face. Please ensure that nothing covers the outline of your eyes, nose or
mouth.
GPhC Dec 2013
Applicants with the currently approved GPhC qualifications and work experience
Section 10 Equality Monitoring Form
You are not required to provide this information if you do not wish to do so but would be helpful if you do.
Section 11 Payment for application for registration as a pharmacy technician
When you apply to register with us you need to pay the appropriate fees
An application fee. This covers our costs for checking the documents you have provided
The first entry fee. This covers our costs for putting and maintaining your name on the register
for 12 months from the date of entry.
You need to submit both the application fee and the first entry fee with your application.
Please note you:
must make your payment by credit or debit card as we no longer accept cheque payments.
should complete the Payment Form included in the application pack providing your card details.
will not be registered as a pharmacy technician until we have taken the first entry fee payment.
If you send in your application without the correct fees your application will be returned to you.
GPhC Dec 2013
Applicants with the currently approved GPhC qualifications and work experience
Guidance on providing supporting documents
You will be required to visit a solicitor and additionally you will need to contact the General Register Office (GRO).
Certified copies
We recommend you send certified copies (not the originals) of the following documents:
Evidence of name change document(s) (where appropriate) [excluding a marriage
certificate]
Passport. If you do not have a current passport - see advice below.
Qualification certificate(s)
Only UK registered solicitors can certify your documents. The official must write on each photocopy:
“I certify that I have seen the original document and that this is a true copy”,
sign,
date and
provide an official solicitor’s stamp.
No liquid paper amendments or alterations of any other kind are permitted to certified copies.
Original duplications from the General Register office
Marriage certificate
Birth certificate
Please see reference 1 in footer below
Changes in name
All the names on your birth certificate, passport, qualification certificate and application form must be exactly
the same, which means word for word, letter for letter. This includes any middle names or initials you may
have and any changes in spelling or order.
You must provide documentation to support all changes to your name, for instance a marriage certificate,
Deed Poll or Certificate of Civil Partnership. If you are not able to do this, you must see a solicitor and
complete the relevant section of the statutory declaration form.
th
Reference 1: Due to Crown Copyright, from the 5 February 2013 the GPhC will not be able accept certified copies of Birth Certificates
from anyone born in the UK. This also applies to certified copies of marriage certificates.
You will now need to provide, with your application, a duplicate birth certificate issued by General Register Office as proof of your date
of birth, or a duplicate marriage certificate issued by General Register Office if required. This document will not be returned to you and
will be held on record by the GPhC.
GPhC Feb 2013
Applicants with the currently approved GPhC qualifications and work experience
Translations for documents not in English
Any document that is not written in the English language MUST be accompanied by a translation.
You must provide the original translation together with a solicitor certified copy of the document which is
not in English.
Translations must be carried out by a professional translator.
The translator must sign and date the translation and provide their name and business address.
The translator must also certify that they are authorised to translate from the particular foreign language
into English, and that the translation produced is true and accurate. The certification must be on the same
page as the translation or be attached to the translation.
The translation must be a literal translation NOT an interpretation of the original document.
All certifications and ink stamps on the original document must also be translated.
Contact your embassy for a list of official translators.
GPhC Feb 2013
Applicants with the currently approved GPhC qualifications and work experience
Applicants without passports
If you do not have a current passport you should send certified copies of both your:
UK driving licence (Full or Provisional), AND
NHS card or National Insurance card.
Both the photo card and paper part of the driving licence must be provided. The driving licence must be
current.
If you do not have a current photo card driving licence you should send:
NHS card or a National Insurance card (certified copy), AND
three of the following original documents (we will return them to you by recorded delivery)
o Bank/building society, credit card or financial statement (such as a pension statement)
o P45/P60
o Utility bill
o TV licence
o Addressed payslip
o Council tax or benefit statement
o CRB disclosure certificate
All documents must be dated within the last 12 months of the date your application is received by us.
The details on the document (including address) must be the same as the details on your application form.
GPhC Feb 2013
Applicants with the currently approved GPhC qualifications and work experience
Academic Transcripts for overseas qualifications
An academic transcript is a full transcript of your academic record for your pharmacy qualification. It must
show the years of study, the subjects you studied and the marks you obtained in each examination. It must be
certified by the relevant officer at the university or academic body.
Letters of good standing
Evidence of being registered should be provided in a Letter of Good Standing or Certificate of Current
Professional Status issued by the appropriate authority of the country or state in which you originally qualified.
The certificate should be issued no more than six months before the date that you expect to apply to register.
If you have practised within the last five years in countries or states other than that in which you qualified you
are also required to provide a Letter of Good Standing or Certificate of Current Professional Status issued by
each appropriate authority of every such country or state.
If you have not maintained your overseas registration, then you are required to obtain a certificate from all of
the relevant authorities confirming the following:
That you are no longer registered with that authority, but that the qualification you hold entitles
you to register AND
That if you wanted to re-register in the future, then there are no matters of a disciplinary or
criminal nature existing, and no pending disciplinary or criminal investigations, which would
prevent the authority from re-registering you and permitting you to resume practice as a
pharmacy professional within their jurisdiction.
What is a Statutory Declaration?
When submitting your registration documents, please bear in mind that the names on your birth certificate,
qualification certificate, proof of identity document(s) and application for registration must be identical in
every way. That includes any middle names or initials you may have and any changes in spelling or order. If the
names on these documents are not identical, you must see a solicitor and complete the relevant sections of the
Statutory Declaration. Failure to do this will delay your registration. If any of the following apply, you will need
to see a solicitor to complete a Statutory Declaration:
You do not have a Birth Certificate or your Birth Certificate is not written in English. COMPLETE
DECLARATION ‘A’
The registration date on the Birth Certificate is not within one year of the date of birth. COMPLETE
DECLARATION ‘A’
You want to register in a name other than that on your Birth Certificate, e.g. additional/dropped names
or letters. (The name you put on the Statutory Declaration should be identical to that which you put on
your Application for Registration Form.) COMPLETE DECLARATION ‘B’
Names on your qualification certificates or Proof of Identity Document(s) are not identical in every way
to those on your Birth Certificate and Application for Registration Form. (All names must be identical:
word for word, letter for letter and in the same order. Initials are not acceptable.) COMPLETE
DECLARATION ‘C’
GPhC Feb 2013
Applicants with the currently approved GPhC qualifications and work experience
Application form
for
registration as
a pharmacy
technician
THIS APPLICATION FORM IS FOR APPLICANTS APPLYING WITH
THE CURRENT GPhC APPROVED QUALIFICATIONS AND WORK
EXPERIENCE.
Pharmacy Technician Registration,
General Pharmaceutical Council
129 Lambeth Road, London SE1 7BT
[email protected]
www.pharmacyregulation.org
tel: 0203 365 3400
GPhC Feb 2013
Applicants with the currently approved GPhC qualifications and work experience
THIS APPLICATION FORM IS FOR APPLICANTS APPLYING WITH THE CURRENT GPhC APPROVED
QUALIFICATIONS AND WORK EXPERIENCE.
PLEASE NOTE APPLICATIONS MAY TAKE AT LEAST 4 WEEKS TO PROCESS.
1. Personal details
1.1 Title
Mr
Mrs
Ms
Miss
Other (please specify)
1.2 Surname(s)
1.3 Forename(s)
1.4 Date of birth
1.5 Home Address
1.6 Postcode
Country
1.7 Nationality
1.8 Home phone
Work phone
1.9 Mobile
1.10 Email address
GPhC Feb 2013
Applicants with the currently approved GPhC qualifications and work experience
2. Type of application
2.1 Which application process applies to you
Please tick one box
Applicant with approved UK qualifications and 2 year qualifying period of work experience
Applicant with approved UK qualifications and evidence of non-UK pharmacy qualification
and qualifying period of work experience
3. Previous applications and Registration with other bodies
3.1 Have you ever applied previously for registration with the Royal Pharmaceutical Society of Great Britain
(RPSGB) or the General Pharmaceutical Council (GPhC), either as a pharmacy technician or as a
pharmacist or undertaken preregistration training with the RPSGB or the GPhC?
Yes
No
If you have answered ‘yes’ to question 3.1 please state your application, registration or preregistration
number/ type of application/ date of application
3.2 Are you currently or have you previously been registered with any UK statutory health regulatory body
(any member body of the Council for Healthcare Regulatory Excellence) or a health regulatory body
outside Great Britain?
Yes
No
If you have answered ‘yes’ to question 3.2 please give details and provide a letter of good standing
Name of body
Registration number
4. Fitness to practise
By virtue of the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975 and the Rehabilitation
of Offenders Act 1974 (Exclusions and Exceptions) (Scotland) Order 2003, you are exempt from the
provisions of Section 4(2) of the Rehabilitation of Offenders Act 1974. Therefore you are not entitled
to withhold information about convictions which for other purposes are spent under the provisions
of the Act and failure to disclose such convictions could result in disciplinary action
4.1 Has a determination ever been made against you by a regulatory body in the United Kingdom
responsible under any enactment for the regulation of a health or social care profession to the effect
that your fitness to practise as a member of a profession regulated by that body is impaired, or a
determination by a regulatory body elsewhere to the same effect?
GPhC Feb 2013
Yes
No
Applicants with the currently approved GPhC qualifications and work experience
4.2 Do you currently have any problems with your physical or mental health that may impair your ability to
practise safely and effectively or which otherwise impairs your ability to carry out your duties in a safe
and effective manner?
Yes
No
4.3 Have you previously been convicted or cautioned for a criminal offence in the British Islands or
elsewhere (which, if committed in England, Scotland or Wales would constitute a criminal offence) or
have you previously agreed to be bound over to keep the peace by a Magistrates’ Court in England or
Yes
Wales?
No
Please note that Road Traffic offences in which the person committing the offence has been offered
the option of paying a fixed penalty (e.g. certain speeding offences etc) will not be treated as a
conviction for the purposes of registration and need not be declared.
4.4 Have you previously agreed to pay a penalty under section 115A of the Social Security Administration
Act 1992 (penalty as alternative to prosecution)?
Yes
No
4.5 Are you currently under investigation by any regulatory body (other than the GPhC) or criminal
enforcement authority (e.g. police or NHS Counter Fraud Service) in the British Islands or elsewhere?
Yes
No
4.6 Have you previously accepted a conditional offer under section 302 of the Criminal Procedure (Scotland)
Act 1995 (fixed penalty: conditional offer by procurator fiscal) or have you previously been subject to an
order under section 246(2) or (3) of the Criminal Procedure (Scotland) Act 1995 discharging you
absolutely (admonition and absolute discharge)?
Yes
No
4.7 Have you previously been included by the Independent Safeguarding Authority (also known as the
Independent Barring Board) barred list (in England, Wales or Northern Ireland) or the children’s list or
adult’s list maintained by the Scottish Ministers?
Yes
No
If you have answered ‘yes’ to any of the questions please provide details on the Something to Declare
form with your application. The ‘something to declare’ form is available on our website
www.pharmacyregulation.org by email to [email protected] and by telephone on 0203
365 3400.
GPhC Feb 2013
Applicants with the currently approved GPhC qualifications and work experience
5. Education and training
Applicants should provide details of pharmacy technician qualification(s) gained in the United Kingdom.
Applicants must hold one of the approved competency based qualification and one of the approved
knowledge based qualification and provide solicitor certified photocopies of all relevant qualification
certificates with their application.
5.1 Title of knowledge based qualification
5.2 Date commenced (month and year)
5.3 Date awarded (month and year)
5.4 Name of course provider
5.5 Title of competency based qualification
5.6 Date commenced (month and year)
5.7 Date awarded (month and year)
5.8 Name of course provider
5.9 Title of non-UK pharmacy qualification (if applicable)
5.10 Date commenced (month and year)
5.11 Date awarded (month and year)
5.12 Name of university
5.13 Country
GPhC Feb 2013
Applicants with the currently approved GPhC qualifications and work experience
6. Work experience
Provide information on your work experience as a pre-registration trainee pharmacy technician. You
must provide evidence of having completed a minimum of two years relevant work-based experience in
the UK under the supervision, direction or guidance of a pharmacist to whom you have been directly
accountable for not less than 14 hours per week. (Please see section 7 of the GPhC Criteria for initial
registration as a pharmacy technician). During these two years, you must have completed at least 1260
hours of work experience (excluding sickness absence, maternity leave and holidays) and at least 315
hours of work experience in each year.
You can include work experience during your pharmacy technician courses and up to 3 months
before the start of the course provided that during this time you have been working and carrying
out the roles of a pre-registration trainee pharmacy technician in the United Kingdom, Isle of Man
or Channel Islands under the supervision, direction or guidance of a pharmacist to whom you have
been directly accountable.
If you have a non-UK pharmacy qualification you have to provide evidence of this (see guidance
notes) and of having worked in the UK as a pre-registration trainee pharmacy technician under the
supervision, direction or guidance of a pharmacist to whom you have been directly accountable for
not less than 14 hours per week.
Gaps in work experience - you must tell us if there are any gaps in your work experience, e.g.
maternity leave, long term sick leave. On a separate sheet or covering letter, give a brief reason for
the gap and start / end date.
A.
Work experience in year 1
Name and address of organisation
Hours worked per week,
Provide details on a separate sheet if there is a variation
Start date (dd/mm/yy)
End date (if applicable) (dd/mm/yy)
Job Title
Main responsibilities / duties
Name and job title of your supervising pharmacist and their GPhC registration number
Contact number of supervising pharmacist
GPhC Feb 2013
Applicants with the currently approved GPhC qualifications and work experience
B.
Work experience in year 2
Name and address of organisation
Hours worked per week
Provide details on a separate sheet if there is a variation
Start date (dd/mm/yy)
End date (if applicable) (dd/mm/yy)
Job Title
Main responsibilities / duties
Name and job title of your supervising pharmacist and their GPhC registration number
Contact number of supervising pharmacist
GPhC Feb 2013
Applicants with the currently approved GPhC qualifications and work experience
C.
Any additional work experience to complete approved UK qualifications or work experience
requirement
Name and address of organisation
Hours worked per week
Provide details on a separate sheet if there is a variation
Start date (dd/mm/yy)
End date (if applicable) (dd/mm/yy)
Job Title
Main responsibilities / duties
Name and job title of your supervising pharmacist and their GPhC registration number
Contact number of supervising pharmacist
Please continue you career history on separate sheets if necessary
GPhC Feb 2013
Applicants with the currently approved GPhC qualifications and work experience
7. Declaration by applicant – This declaration must be completed and dated before you
give your application and supporting documents to the countersignatory for checking.
I declare that:
7.1 I am applying for registration in Part 2 of the Register and I hereby declare that, in accordance with
Article 20(3) of the Pharmacy Order 2010, I intend to practise as a pharmacy technician in Great Britain,
the Channel Islands or the Isle of Man.
7.2 The information that I have provided in this application for registration is complete, true and accurate. I
am also aware that I am under a duty to notify the Registrar of any changes to my name, home address
or other contact details within one month starting on the day on which the change occurred.
7.3 I will adhere to the standards relating to conduct, ethics and performance and continuing professional
development published by the General Pharmaceutical Council.
7.4 I have in place appropriate indemnity arrangements.
7.5 I accept that I am under a duty to notify the Registrar if there is any change in the circumstances relating
to the fitness to practise declaration that I have made within 7 days starting on the day on which the
event occurred.
I understand that
7.6 If I am found to have given false or misleading information in connection with my application for
registration in the Register, this may be treated as misconduct, which may result in my removal from the
Register.
Signature
Date
Data Protection Statement
The GPhC is a data controller registered with the Information Commissioner’s Office. The GPhC makes use of
personal data to support its work as the regulatory body for pharmacists, pharmacy technicians and retail
pharmacy premises in Great Britain. Data may be shared with third parties in pursuance of the GPhC's statutory
aims, objectives, powers and responsibilities under the Pharmacy Order 2010, the rules made under the Order
and other legislation. Personal data may be processed for purposes including (but not limited to) updating the
register, administering and maintaining registration, processing complaints, compiling statistics and keeping
stakeholders updated with information about the GPhC. Information may be passed to organisations with a
legitimate interest including universities and research institutions. Please note that the GPhC will not share
your personal data on a commercial basis with any third party.
GPhC Feb 2013
Applicants with the currently approved GPhC qualifications and work experience
8A. Declaration by countersigning pharmacist or pharmacy technician
This section must be completed by a practising pharmacist or pharmacy technician with current UK
registration who is in good standing.
I declare that:
8.1 I am on the GPhC/PSNI Register
8.2 I am in good standing with the GPhC/PSNI
8.3 I have checked the documents to be submitted and confirm that they are all present and have been
enclosed with this application form
8.4 To the best of my knowledge the information given in this application and in any supporting documents
is true, complete and accurate and relates to the applicant.
8.5 I know of no reason why this applicant should not be registered as a pharmacy technician
Name (Please print)
Registration number
Signature
Date
GPhC Feb 2013
Applicants with the currently approved GPhC qualifications and work experience
8B. Declaration by supervising pharmacist
This section must be completed if application submitted prior to completion of the 2 years relevant work
based experience.
I declare that:
8.6
I am on the GPhC/PSNI Register
8.7
I am in good standing with the GPhC/PSNI
8.8
The applicant will have complete the relevant period of work experience by:
(Insert date below as dd/mm/yy)
8.9
To the best of my knowledge the information given above is true and accurate and relates to the
applicant.
8.10 Should I become aware of any changes to the fitness to practise declaration completed by the
applicant I will notify the GPhC within 7 days of becoming so aware and advise the applicant to do
likewise. I am aware of my professional obligations to do so.
Name (Please print)
Registration number
Signature
Date
GPhC Feb 2013
Applicants with the currently approved GPhC qualifications and work experience
9. Photograph certification
This section must be completed by the person who signs the back of the photograph
9.1 Name
9.2 Address
9.3 Country
9.4 Occupation
9.5 Phone
9.6 Email address
By countersigning this application, you agree that the General Pharmaceutical Council (GPhC) may
contact you to verify the information that you have provided.
I declare that I have signed the photograph enclosed and that I have known
for
years and the information I have provided is correct.
Please insert no. of years above
I certify this is a true
likeness of
Give applicants full
name and title
Signature
Signature of
certifying person
and date certified
Date
Staple certified photograph here
GPhC Feb 2013
Applicants with the currently approved GPhC qualifications and work experience
10. Equality monitoring
10.1 What is you ethnic group? Please tick one
White
British
Irish
Other
African
Other
Black or Black British
Caribbean
Mixed
White and Black Caribbean
White and Black African
White and Asian
Other Mixed (please specify)
Asian or Asian British
Indian
Pakistani
Bangladeshi
Other Asian (please specify)
Other ethnic group
If other please specify
10.2 What is you gender? Please tick one
Male
Female
10.3 What is your sexual orientation? Please tick one
Heterosexual
Lesbian / Gay
Bisexual
10.4 What is your religion? Please tick one
None
Christian
Buddhist
Hindu
Jewish
Muslim
Sikh
Other
If other please specify
10.5 Do you consider that you have a disability? Please tick one
Yes
GPhC Feb 2013
No
Applicants with the currently approved GPhC qualifications and work experience
11. Payment for application for registration as a pharmacy technician
11.1 Name of applicant
Charge this card with the sum of (payment by credit card will incur a surcharge of 2%):
Application Fee:
Debit card: £102
Credit card (£102 + £2.04 credit card surcharge): £104.04
£
1
0
2
0
0
£
1
0
4
0
4
£
1
0
8
0
0
£
1
1
0
1
6
First Entry Fee:
Debit card: £108 (First Entry Fee)
Credit card (£108 First Entry Fee + £2.16 credit card surcharge): £110.16
.
Please indicate whether you are paying by:
Debit card
Credit card
Type of card Please tick one:
Mastercard
Visa
Visa Purchasing
Visa Delta
Maestro
Solo
(insert the exact amount
of digits in your card
number only)
Card number
CSC number
(The last 3 digits on the back of the card)
Valid From Date
Expiry Date
Issue number
Issue number for Maestro or Solo cards only. If your card does not have an issue number please enter ‘NA’ in the boxes.
Name of cardholder
#
The name exactly as it appears on the debit or credit card
Address of cardholder
Postcode
Signature
Date (dd/mm/yy)
To be signed by the cardholder
GPhC Feb 2013
Applicants with the currently approved GPhC qualifications and work experience
You need to submit both the relevant application fee and the first entry fee with your application.
The application fee is taken when we receive your application, the first entry fee when your name
is entered onto the Register.
The first entry fee covers the costs of maintaining your name on the register of pharmacy
technicians for twelve months from the date of first entry.
Please note
Fees are non-refundable. The GPhC will not accept cheque payments
An additional £47 administration fee will be levied in the event of an application for registration
having to be returned to the applicant more than once.
GPhC Feb 2013
Applicants with the currently approved GPhC qualifications and work experience
STATUTORY DECLARATION
Instructions for completing the appropriate declaration(s)
You must complete whichever declaration(s) on this page of the form is/are applicable to your situation and
the ‘To be completed by the applicant’ section.
The appropriate declaration(s) on this form must be completed by the applicant in the presence of a solicitor,
who should then complete the ‘Declaration by solicitor’.
DECLARATION A - Inability to provide a birth certificate OR birth certificate not written in English
This declaration must be completed if you are unable to provide the GPhC with a copy of your birth certificate
or if your birth certificate is not written in English.
Please note: To be acceptable your birth certificate must state your full legal name, date and place of birth and
indicate that your birth was registered within 12 months of the date of birth.
DECLARATION B - Using a name other than that on birth certificate
This declaration must be completed when you have changed your name to a different one from that on your
birth certificate or the order in which your names appear on your birth certificate is different from that on
your Application for Registration. Please note that the GPhC requires you to be registered in your full name so
for registration purposes you cannot drop a name which is present on your birth certificate UNLESS you
complete this declaration.
DECLARATION C - If name(s) on supporting documents differ from Application for Registration
All the names on your supporting documents must be identical to the names on your Application for
Registration and birth certificate or marriage certificate (if applicable). If they are not identical, you must
complete this declaration.
PLEASE NOTE - You may need to complete more than one declaration.
Declaration A
Inability to provide birth certificate OR birth certificate not written in English
I,
(Insert full name – this must be identical to that on your application for registration)
of
(Insert home address)
do solemnly and sincerely declare to the best of my knowledge and belief, that at my birth I was given the name
(Insert your name at the time of your birth)
On
/
/
(Insert date of birth DD/MM/YY)
in
/
(Insert town / country))
and that I am unable to obtain a certified copy of my birth certificate or my birth certificate is not written in English.
GPhC Feb 2013
Applicants with the currently approved GPhC qualifications and work experience
Declaration B
Using a name other than that on birth certificate
I,
(Insert full name as written on birth certificate)
of
(Insert home address)
do solemnly and sincerely declare that since
/
/
I have used and in future will be known by the name of
(Insert full name you are now using – this name must be identical to that on your application for registration)
Declaration C
If there is a variation in name between documents
I,
(Insert full name as written on birth certificate or if no birth certificate, use the name as provided in declaration A)
of
(Insert home address)
declare that all documents submitted with my application for registration including the copy of the qualification certificate
relate to me and that all versions of my name relate to one and the same person.
To be completed by the applicant
I
(Insert full name you are now using – this name must be identical to that on your application for registration)
make the declaration(s) overleaf conscientiously believing the same to be true and by virtue of the provisions of the
Statutory Declarations Act, 1835.
Signed
Date
/
/
Declaration by solicitor
Declared at
(Insert full name and address of solicitor’s premises)*
This
day of
before me
Signed
GPhC Feb 2013
(Insert solicitor’s stamp here)
Applicants with the currently approved GPhC qualifications and work experience