Which region in the UK are you based in?
Please choose
Northern Ireland
Scotland
Wales
East Midlands
East of England
Kent Surrey and Sussex
London
North East
North West
South West
Thames Valley
Wessex
West Midlands
Yorkshire and the Humber
Primary employer type
Please choose
Hospital
Community
HEE
School of Pharmacy
Primary Care e.g. CCG/GP
NHS Wales Shared Services Partnership
Military
Other
Ethnicity
Please choose
White – British
White – Irish
Any other White background
Mixed - White and Black Caribbean
Mixed - White and Black African
Mixed - White and Asian
Any other mixed background
Asian – Indian
Asian – Pakistani
Asian – Bangladeshi
Any other Asian background
Black – Caribbean
Black – African
Any other black background
Chinese
Any other ethnic background
Prefer not to say
The data collected in this form will be used to monitor panel diversity and not to select panels. Diversity information will always be anonymised and will not be linked to your other personal information.
Any personal data collected will be treated as confidential in line with the principles of the Data
Protection Act 1998.
Please provide a contact mobile number *
Please provide us with your NHS email address (Please note we will not be able to provide interview documentation without this)
What is your current training level?
Please choose
ST6
ST7
Consultant
If your current training level is below ST5, you will be unable to sign up as a panellist for IMT interviews.
