1. careers

Application for
registration as
a pharmacy
technician
Applicants with EEA pharmacy technician qualifications
Pharmacy Technician Registration,
General Pharmaceutical Council
129 Lambeth Road,
London SE1 7BT
[email protected]
www.pharmacyregulation.org
tel: 0203 365 3400
GPhC January 2013
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 a member state that entitles you to practise as pharmacist
or pharmacy technician in that country
You have a pharmacy qualification gained in your country of qualification, 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 became mandatory (compulsory). You will need to be registered as a pharmacy
technician to work as or call yourself a pharmacy technician in Great Britain.
GPhC January 2013
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 January 2013
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.
To help us process your application as quickly as possible, please check your documents very carefully to
make sure you have provided all that is required and in the format required (eg certified copy or original
document). We recommend that you make use of the checklist provided in the information pack.
4.
. 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.
A solicitor or notary can 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 by an appropriate person
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 £47 administration fee if we have to
return applications for missing information more than once.
GPhC January 2013
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 January 2013
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)
Assessment Framework
* 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. 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.
*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.
Any documents not in English must be translated into English
GPhC January 2013
EEA Pharmacy Technician Application
Send your completed forms and other documents to
Applications Team 2,
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.
GPhC January 2013
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 B 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 January 2013
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.
GPhC January 2013
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’. A full assessment of your education and training will be
performed by our evaluators and you will be provided with a list of recommendations where applicable.
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.
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.
GPhC January 2013
EEA Pharmacy Technician Application
You must provide a CV 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
Against an off-white, cream or light grey plain background so your features are clearly
distinguishable
GPhC January 2013
EEA Pharmacy Technician Application
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. After satisfactory completion of the recommendations set by the Evaluators you will be required to
provide the first entry fee. This covers our costs for putting and maintaining your name on the register.
GPhC January 2013
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 or identity card..
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 an authorised 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 January 2013
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 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 January 2013
EEA Pharmacy Technician Application
Assessment Framework
The Assessment Framework describes the standards for the initial education and training of
pharmacy technicians. This self assessment must be completed using and referencing your syllabus.
For any aspect of the framework which you mark ‘yes’ you must also indicate the course/subject
where this aspect was covered. You must indicate the subject in such a way to enable the Council’s
evaluators to cross-reference what you have written against your curriculum.
For example, if your curriculum uses course codes then you must provide these on the Assessment
Framework. Otherwise, you must use the indexing system used in your curriculum, for example,
year of study, department, semester, subject title etc.
Please ensure that your Assessment Framework is completed correctly and clearly. If this does not
accurately reflect your syllabus you will be required to complete it again.
Please note if the National Occupational Standards (NOS) have been covered by training or
employment please provide an assessment from your supervisor/employer of your performance
against the relevant standard. This can be provided on a separate sheet. This assessment(s) must be
accompanied with a copy of your job description (detailing your role) and your supervisor/employer
(s) must provide comment on your performance against this role.
This assessment and job descriptions will enable the GPhC’s assessors to compare your work
experience against the national requirement for education and registration.
GPhC January 2013
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 January 2013
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 January 2013
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 January 2013
EEA Pharmacy Technician Application
3. Education and training
Please provide evidence of qualification (s) and/or professional experience. If you have more than two
relevant qualifications, please provide further details on a separate sheet of paper. This is recommended
as this could affect the assessment of your application by the GPhC’s evaluators. All qualifications must be
accompanied by a detailed syllabus (curriculum) and an academic transcript (please see the
‘Documentation’ section for further information.
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
GPhC January 2013
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 January 2013
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 January 2013
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 January 2013
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 January 2013
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 January 2013
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 January 2013
Please tick one
No
EEA Pharmacy Technician Application
8. Payment for application for registration as a pharmacy technician
8.1 Name of applicant
Please charge this card with the sum(s)
Application fee £102
Scrutiny fee £194
We will process your application fee and scrutiny fee payment when we validate your application
First entry fee £108
Please indicate whether you are paying by
Debit card
Credit card
Payment by credit card will incur a surcharge of 2% from 1 Sept 2011
onwards
Type of card Please tick one
Mastercard
Visa
Visa Purchasing
Visa Delta
Maestro
(insert the exact amount
of digits in your card
number only)
Card number
CSC number
Valid From Date
Solo
(The last 3 digits on the back)
of the card)
/
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
digits in your card
The name exactly as it appears on the debit or creditnumber
cardonly)
Address of cardholder
digits in your card number only)
Postcode
Signature
Date (dd/mm/yy)
To be signed by the cardholder
GPhC January 2013
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 £108 is the first entry fee for
applicants entering onto the register up to and including September 2013. The fee for entrance onto the
register after this date will be the subject of a GPhC fees consultation 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 your 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 £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 January 2013
EEA Pharmacy Technician Application