Pharmacy Technician Registration, General Pharmaceutical Council 129 Lambeth Road,
Pharmacy Technician Registration, General Pharmaceutical Council 129 Lambeth Road, London SE1 7BT [email protected] www.pharmacyregulation.org tel: 0203 365 3400 GPhC April 2011 EEA Pharmacy Technician Application Introduction You should use this application pack if you are an EEA (European) or Swiss national and want to apply to register as a pharmacy technician in Great Britain and one of the following apply: You have a pharmacy qualification gained in your country of qualification that entitles you to practise as a pharmacist or pharmacy technician in that country, which has been recognised by a Member State and you have been permitted to work as a pharmacist or pharmacy technician in that Member State, or You have a pharmacy technician qualification awarded in another Member State which is required for working as a pharmacy technician in that Member State or, if the education and training is not regulated in that Member State, full-time professional experience as a pharmacy technician for 2 years, or for an equivalent period on a part-time basis, during the previous 10 years. We will evaluate your education and training and decide whether you are eligible for registration or not. You may be required to complete either an adaptation period or an aptitude test covering theoretical knowledge and practical skills, which have not been covered as part of your education and training, in order to meet our registration requirements. On 1 July 2011 registration will become mandatory (compulsory). You will need to apply to register before registration becomes mandatory to continue working as a pharmacy technician or call yourself a pharmacy technician in Great Britain. GPhC April 2011 EEA Pharmacy Technician Application What is registration for? Protection of title. Registration is your licence to practise as a pharmacy technician. Only those who meet and maintain recognised professional standards will be able to register and practise as pharmacy technicians and use the title. Professional recognition We approve new qualifications and set other criteria for entry onto the register. We define the standards for the training and education of pharmacy technicians. Upholding the reputation of pharmacy technicians The reputation of an entire professional group can be compromised by a few individuals who, through poor performance or misconduct, do not keep the same high standards as the rest of the group. We have powers to bring proceedings against any registered pharmacy technician who is considered to be practising in a way which puts the public at risk. Defined standards of professional conduct All registered pharmacy technicians must comply with the GPhC’s Code of Ethics which sets out our expectations regarding the professional conduct of pharmacists and pharmacy technicians. Once registered you will need to have indemnity insurance in place. You may already be covered by your employer’s insurance but it is your responsibility to check that you are appropriately covered! Maintaining professional competence Keeping up to date in your role as a pharmacy technician is vital. All pharmacy technicians, on the GPhC Register, must undertake continuing professional development (CPD). See website www.uptodate.org.uk. CPD enables registered pharmacy technicians to demonstrate to employers, the NHS and patients that they are maintaining and building on their capabilities. CPPE provide online study packages and workshops throughout the UK, to help pharmacy technicians stay up to date. These are free to registered pharmacy technicians. GPhC April 2011 EEA Pharmacy Technician Application Preparing and completing your application 1. Read all the guidance carefully. 2. Use a black ball point pen, WRITE IN BLOCK CAPITALS and mark boxes clearly to answer the questions on the application form. No liquid paper amendments or alterations of any other kind are permitted on the application form or certified copies of documents. 3. Follow the guidance to answer each 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 supporting documents. Arrange for any documents not in English to be translated into English. 5. Contact the relevant authorities to arrange for them to send the relevant documents directly to us. 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. Make clear, legible copies of your documents. Arrange to meet with the solicitor or notary who will certify photocopies of your documents as true copies of the original. 8. Arrange for your photograph and section 6 of your form to be signed. 9. Send your completed application to us as instructed on the checklist. It is important that your application is double checked before sending it to us. If any information or documents are missing we will return your application and your registration will be delayed. We will charge £46 administration fee if we have to return applications for missing information more than once. GPhC April 2011 EEA Pharmacy Technician Application 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 initial registration as a pharmacy technician Guidance on registration with the GPhC and Fitness to Practise. Advises how to answer the questions on the fitness to practise form. 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 April 2011 EEA Pharmacy Technician Application Registration application checklist Application form (including photograph certification) Payment form Birth certificate – certified copy (and/or statutory declaration) Marriage certificate/s (if you are married) – certified copy (or statutory declaration) Qualification certificate – certified copy Passport – certified copy Photograph – attached to section 6 photograph certification section Stamped self addressed postcard for confirmation that we received your application The syllabus (detailed curriculum) of your qualification Academic transcript from your awarding body (college/university) * A certificate from the Competent Authority in your Country (usually the Ministry of Health or the Ministry of Education) which states: the name or title of your qualification the name of the awarding institution The number of the diploma/certificate and the date the diploma/certificate was issued the level of that qualification in relation to Article 11 of Directive 2005/36/EC and that the qualification you hold entitles you to work as a pharmacy technician, a pharmacist's assistant or pharmacist (as appropriate) in that country. * If you are or have been registered with a regulatory body a letter of good standing from your regulatory body, in the country in which you qualified and from each country in which you have worked as a pharmacy technician. If you have not been registered with a regulatory body then we require an extract of judicial record/police clearance from the country in which you qualified, and from each country in which you have worked as a pharmacy technician. The judicial record/police clearance can be provided by you, the applicant. * Your letter of good standing and certificate from the Competent Authority must be sent directly from the issuing body to our address as below. If we consider that they have been supplied by either you or a third party, they will be rejected and you will have to arrange for new documents to be sent. We will keep your documents safely if they arrive before your application form and match them up with your form. Any documents not in English must be translated into English GPhC April 2011 EEA Pharmacy Technician Application Send your completed forms and other documents to Pharmacy Technician Registration, General Pharmaceutical Council 129 Lambeth Road, London SE1 7BT 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. Wait at least four weeks before contacting us about the progress of your application. GPhC April 2011 EEA Pharmacy Technician Application Guidance for filling in 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. If you wish to be registered in a different name to that printed on birth certificate you must provide: A certified 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. Please contact us for a statutory declaration form. 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 in the United Kingdom or authorised British Embassy official in your home country. 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 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 Your address You must keep your contact details up to date. If you change your address you must notify us within one month of the date of change. 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. GPhC April 2011 EEA Pharmacy Technician Application Section 2 Fitness to Practise Question 2.1 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 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 2.2 and 2.3 Registration with other health regulatory bodies 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. Questions 2.4 to 2.10 Legal and disciplinary proceedings 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 tick either yes or no for questions 2.4 to 2.10. If you have answered yes to any of the questions you must complete the Something to Declare form. 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. If you are registered with more than one body please provide details on a separate sheet. GPhC April 2011 EEA Pharmacy Technician Application Section 3 Education and training Question 3.1 Title of qualification Provide the title of your qualification. Question 3.2, 3.3 Name and address of awarding institution Provide the name and address of the awarding institution. Question 3.4 Date commenced Provide the month and year you started the course Question 3.5 Date awarded Provide the month and year you were awarded the qualification Question 3.6: Mode of study Provide details of the mode of study, for instance if it was full time or part time. Question 3.7 Work experience Give details of any required periods of work experience. If you have more than one qualification please continue on a separate sheet. Question 3.8 to 3.12 Knowledge of UK pharmacy law and ethics Knowledge of UK pharmacy law and ethics is essential for pharmacy practice and we are required to assess your education and training in UK pharmacy law and ethics. If you have covered the topic tick ‘covered’. If you have covered the topic please provide details of how you have done this. This could be through formal training courses, employer led training, induction programmes, mentoring by a supervising pharmacist(s), books and periodicals you have read. If you have not covered a topic tick ‘not covered’. If you have not completed any training on UK pharmacy law and ethics or have not covered some areas it is likely that our assessors will require you to complete the relevant unit on UK laws and ethics – NVQ level 3 in Pharmacy Services, before recommending your registration. A full assessment of your education and training will be performed by our evaluators and you will be provided with a list of recommendations. Section 4 Career History Only include work experience after the date you started your pharmacy technician course, even if you were working in pharmacy before you started your course. GPhC April 2011 EEA Pharmacy Technician Application You must provide information on your work experience as a pharmacy technician and student technician, including main responsibilities and duties. Only include work experience that is pharmacy-related. You must provide a covering letter if there are gaps between jobs, because e.g. you have been travelling, you have taken any maternity leave or periods of sickness, or there have been any changes in hours or responsibilities. Section 5 Declaration by applicant The GPhC register is divided into Parts. Part 2 is for registration as a pharmacy technician. You must sign and date the declaration. Fraudulently procuring an entry in the pharmacy technicians’ register will be treated as misconduct and may result in removal from the Register. Section 6 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. Photograph Certification Requirements for the photograph The photograph must be: Taken within the last month In colour GPhC April 2011 EEA Pharmacy Technician Application Against an 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. Section 7 Equality Monitoring Form You are not required to provide this information if you do not wish to do so. Section 8 Payment for application for registration as a pharmacy technician When you apply to register with us you need to pay the following fees 1. The application fee. This covers our costs for checking the documents you have provided 2. The scrutiny fee. This covers our costs for evaluating your qualification against the national requirements for registration. 3. The first entry fee. This covers our costs for putting and maintaining your name on the register. GPhC April 2011 EEA Pharmacy Technician Application You need to submit the application fee and scrutiny fee with your application. We will contact you for the first entry fee once the evaluation of your application has been completed if your application has been successful. Please note: The current fees are provided in section 8 of the form. You must make your payment by credit or debit card. We do not accept cheque payments. You should complete section 8 of the form providing your card details. You will not be registered as a pharmacy technician until we have taken the application, scrutiny and first entry fee. Guidance on providing supporting documents Certified copies We recommend you send certified copies (not the originals) of the following documents: Birth certificate Marriage certificate or other acceptable document(s) (where appropriate) Passport. If you do not have a passport, contact us for advice. Qualification certificate Officials who can certify your documents include UK registered solicitors, the legal equivalent in your home country, an authorised officer of a British embassy or a notary public, in your home country. 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 solicitors stamp. If a document is not in English, you must provide a certified translation in English, and the certified copy of the original language document. No liquid paper amendments or alterations of any other kind are permitted to certified copies. GPhC April 2011 EEA Pharmacy Technician Application 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. Letters of good standing and eligibility to practice If the profession of a pharmacy technician is a regulated profession in the country in which you obtained your pharmacy technician qualification and/or in the country in which you practised as a pharmacy technician; We require a letter confirming your good standing and eligibility to practise from the country in which you obtained your qualification and from the country in which you practised if this is different. This document must be sent direct to our office, by the regulatory/professional authority. The authority must confirm that you have not been the subject of any disciplinary proceedings and that there are no disciplinary proceedings pending against you. If you are or have never been registered with a regulatory/professional authority you must provide a letter from your authority confirming that if you wished to register with that authority, there is nothing adverse known about you which would prevent your registration and ability to practise as a pharmacy technician or pharmacist in your country of qualification. If the profession of a pharmacy technician is not a regulated profession in the country in which you obtained your pharmacy technician qualification and/or in the country in which you practised as a pharmacy technician - you are required to provide an extract of judicial record/police clearance from the country in which you qualified and from each country in which you have worked as a pharmacy technician. A letter of good standing or police clearance certificate must be provided for the country in which you qualified and for each country in which you have practised as a pharmacy technician or pharmacist. GPhC April 2011 EEA Pharmacy Technician Application 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 Address including postcode 1.6 Country 1.7 Nationality 1.8 Home phone 1.9 Work phone / mobile 1.10 Email address GPhC April 2011 EEA Pharmacy Technician Application 2. Fitness to practise 2.1 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 2.1 please provide details, including your application, registration or preregistration number 2.2 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 2.2 please provide name of body and registration number and a letter of good standing. 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 2.3 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? Yes No 2.4 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 2.5 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 GPhC April 2011 EEA Pharmacy Technician Application have you previously agreed to be bound over to keep the peace by a Magistrates’ Court in England or Wales? Yes 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 renewal in the Register and need not be declared. 2.6 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 2.7 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 2.8 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 2.9 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 above you are required to submit a ‘something to declare’ form with your application. The ‘something to declare’ form is available on our website www.pharmacyregulation.org by email at [email protected] and by telephone on 0203 365 3560. GPhC April 2011 EEA Pharmacy Technician Application 3. Education and training Applicants are required to provide evidence that their qualification and/or professional experience are equivalent to the Core Underpinning Knowledge and Core Standards of Practice required for qualification as a pharmacy technician in Great Britain. If there is a substantial difference between the education and training you received to obtain your qualification and the UK qualification requirements, you may be required to complete either an adaptation period or an aptitude test. 3.1 Title of qualification 3.2 Name and address of awarding institution 3.3 Country 3.4 Date commenced (month and year) 3.5 Date awarded (month and year) 3.6 Mode of study (for instance full time, part time day release) 3.7 If you training included any periods of mandatory work experience, please provide details Knowledge of UK pharmacy law and ethics is essential for pharmacy practice and we are required to assess your education and training in UK pharmacy law and ethics. GPhC April 2011 EEA Pharmacy Technician Application If you have covered the topic tick ‘covered’. If you have covered the topic please provide details of how you have done this in the box below. This could be through formal training courses, employer led training, induction programmes, mentoring by a supervising pharmacist(s), books and periodicals you have read. If you have not covered a topic tick ‘not covered’. If you have not completed any training on UK pharmacy law and ethics or have not covered some areas it is likely that our assessors will require you to complete the relevant unit on UK laws and ethics – NVQ level 3 in Pharmacy Services, before recommending your registration. A full assessment of your education and training will be performed by our evaluators and you will be provided with a list of recommendations. 3.8 Legislation relating to medicines Medicines Act 1968 Covered Not covered Misuse of Drugs Act 1971 Covered Not covered Poisons Act 1972 and Poisons Rules Covered Not covered Methylated spirits Covered Not covered General Pharmaceutical Council Covered Not covered Other organizations within pharmacy Covered Not covered National Health Service Covered Not covered 3.9 Structure and functions of organisations affecting pharmacy GPhC April 2011 EEA Pharmacy Technician Application 3.10 Roles in pharmacy and health Roles undertaken by pharmacists and pharmacy support staff Covered Not covered Roles of other healthcare professionals Covered Not covered Trade descriptions Covered Not covered Consumer protection Covered Not covered Weights and measures Covered Not covered Data protection Covered Not covered COSSH Covered Not covered CHIP2 Covered Not covered HSAWA Covered Not covered Equal opportunities Covered Not covered Disabilities Covered Not covered 3.11 Legislation affecting pharmacy GPhC April 2011 EEA Pharmacy Technician Application 3.12 Factors affecting standards within pharmacy and pharmacies Clinical governance Covered Not covered Risk assessment and management Covered Not covered Standard operating procedures Covered Not covered Professional ethics Covered Not covered GPhC April 2011 EEA Pharmacy Technician Application 4. Career history Applicants should provide their full career history as a pharmacy technician and student technician starting with their most recent role. A. Most recent job title / position Name and address of organisation Hours worked per week Start date (dd/mm/yy) End date (if applicable) (dd/mm/yy) Main responsibilities / duties Name and job title of most recent line manager / supervising pharmacist (delete accordingly) Contact number of most recent line manager / supervising pharmacist (delete accordingly) GPhC April 2011 EEA Pharmacy Technician Application B. Job title / position Name and address of organisation Hours worked per week Start date (dd/mm/yy) End date (if applicable) (dd/mm/yy) Main responsibilities / duties Name and job title of most recent line manager / supervising pharmacist (delete accordingly) GPhC April 2011 EEA Pharmacy Technician Application C. Job title / position Name and address of organisation Hours worked per week Start date (dd/mm/yy) End date (if applicable) (dd/mm/yy) Main responsibilities / duties Name and job title of most recent line manager / supervising pharmacist (delete accordingly) GPhC April 2011 EEA Pharmacy Technician Application 5. Declaration by applicant I declare that 5.1 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. 5.2 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. 5.3 I will adhere to the standards relating to conduct, ethics and performance and continuing professional development published by the General Pharmaceutical Council. 5.4 I have in place appropriate indemnity arrangements. 5.5 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 in Section 2 within 7 days starting on the day on which the event occurred. I understand that 5.6 If I am found to have given false or misleading information in connection with my application for registration, 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 April 2011 EEA Pharmacy Technician Application 6. Photograph certification This section must be completed by the person who signs the back of the photograph 6.1 Name 6.2 Address 6.3 Country 6.4 Phone 6.5 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. Signature Date I certify this is a true likeness of Give applicants full name and title Signature of certifying person and date certified Attach photograph here by one corner All writing must be visible GPhC April 2011 EEA Pharmacy Technician Application GPhC April 2011 EEA Pharmacy Technician Application 7. Equality monitoring 7.1 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 7.2 What is you gender? Male Please tick one Female 7.3 What is your sexual orientation? Heterosexual Please tick one Lesbian / Gay Bisexual 7.4 What is your religion? Please tick one None Christian Buddhist Hindu Jewish Muslim Sikh Other If other please specify 7.5 Do you consider that you have a disability? Yes GPhC April 2011 Please tick one No EEA Pharmacy Technician Application GPhC April 2011 EEA Pharmacy Technician Application 8. Payment for application for registration as a pharmacy technician 8.1 Name of applicant 8.2 Type of card Please tick one Mastercard Visa Visa Purchasing Visa Delta Maestro Solo 8.3 Card number 8.4 Issue date (mm/yy) 8.5 Expiry date (mm/yy) 8.5 Issue number (for Solo and Maestro cards only) If your card does not have an issue number please enter ‘NA’ in the box 8.6 Name of card holder (exactly as it appears on the card) 8.7 Please charge this card with the sum(s) Application fee £100 Scrutiny fee £190 We will process your application fee and scrutiny fee payment when we validate your application First entry fee £142 Signature of cardholder Date (dd/mm/yy) GPhC April 2011 EEA Pharmacy Technician Application We will contact you before we take the first entry fee payment as this may be up to 4 months from receipt of a complete application. This fee will only be collected after your application has been evaluated by the assessors and they have determined that you are appropriately qualified for registration. 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. The fee of £142 is the first entry fee for applicants entering onto the register up to and including September 2012. The fee for entrance onto the register after this date will be the subject of a GPhC fees consultation in 2011 and may be higher. Please note Fees are non-refundable. The GPhC will not accept cheque payments You are required to provide two payments, the application fee and the scrutiny fee with your application. The application fee and scrutiny fee covers the cost of processing you application. 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. We will process the first entry fee payment when your name is put on the register. The first entry fee is required to enter you onto the Register of Pharmacy Technicians and you will not be registered until this payment has been processed. An additional £46 administration fee will be levied in the event of an application for registration having to be returned to the applicant more than once. GPhC April 2011 EEA Pharmacy Technician Application
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