024279809 NCHD Application

7/31/2019 024279809 NCHD Application

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Non-Consultant Hospital Doctor Application Form

Section A - Personal Details

Candidate ID: 024279809

First Name: Aqeel

Family Name: Chaudhry

Address 1: 136 kshmir block, allama iqbal town,lahore

Address 2:

Address 3:Country: PAKISTAN

DayTime Number: +923334038756

Mobile Number: +923219432274

Date Of Birth: 06/04/1985

Email: [email protected]

PPS Number:

Irish Citizen: false

EU Citizen: false

Citizenship Other:

Section A - SHO and Registrar specialty and sub-specialty roles

Role: Senior House Officer

Area: Surgery

Preferred Specialty: General Surgery

Preferred Sub-Specialty:

Second Specialty:

Second Sub-Specialty:

NCHD Application Form Candidate ID: 024279809

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Section A - Hospital Group / Mental Health Service Group Preferences

Hospital Group: Dublin North East

Section B - Visa and Work Permit Status

Do you require a work permit to work inIreland?

Yes

Number on permit / visa

Start date:

End date:

Do you hold a Garda National ImmigrationBureau Card?

No

The stamp number on my card is:

Section C - Irish Medical Council Registration

Are you registered with the Irish MedicalCouncil (IMC)?

No

If yes, please state the name in which youare registered

IMC Registration Number

Type of registration

IMC acceptance letter reference number

If not registered, have you applied forregistration? No

The IMC Reference for your application is


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Section C - Training/Prior Experience

Are you enrolled in a Registrar TrainingProgramme in Ireland at this current time?

No

If yes, please select the postgraduatetraining body responsible for the Registrartraining Programme

Will you be applying to enter HigherSpecialist Training in Ireland in 2012?

No

If yes, please select the postgraduatetraining body you will be applying to

Have you worked as a Senior House Officeror Registrar in Ireland before?

No

If yes, please select the year you startedwork in Ireland. Do not include your internyear


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Section D - Undergraduate Education

University/Medical School Name Nishtar Medical college, Multan/ UHSLahore, Pakistan

Address line 1 nishtar road multan

Address line 2

Address line 3

Address line 4 Pakistan/Punjab

Country PAKISTAN

Date of entry to Medical School 14/01/2004

Date of graduation 13/02/2009

Primary medical qualification MBBS

Overall grade achieved A

Exam Results

Subject Grade

Medicine, surgery, paeds, Gynae &Obstetrics,

A

Higher Qualification/Degree/Diploma

Qualification Name :

Awarding Body :

Date of Qualification :

Postgraduate Exams

Postgraduate Exam Name :

Grade Achieved :

Date :

Skill Courses

Name of Course : ACLS and Trauma Course

Location of Course : AIMC, Jinnah hospital Lahore

Date : 26/06/2009


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Section E - Employment History

Clinical Site Grade Specialty Date From Date To Months inpost

ShaukatKhanummemorialCancerHospital &ResearchCenter

RMO(Resident medicalOfficer)

SurgicalOncology

10/01/2012 04/05/2012 3

WazirHospital,lahore

RMO(Resident medicalOfficer)

Surgery 01/01/2011 31/12/2011 12

WazirHospital,

Lahore

RMO InternalMedicine

17/05/2010 31/12/2010 7

MayoHospital,lahore

Internee Thoracicsurgery

16/03/2010 15/05/2010 2

MayoHospital,lahore

Internee Generalsurgery

16/11/2009 15/03/2010 4

MayoHospital,lahore

Internee Internalmedicine

16/05/2009 15/11/2009 6


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Section F - Publications, Audit & Presentation


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Section G - Aims & Career Objectives

Outline your career objectives, why you wish to gain employment with the HSE as a Non-Consultant Hospital Doctor and what you will contribute to the specialty.

I want specialize in field of General surgery proceed to Orthopedics..I am interested to work in Irish health system because of its higher standards ofhealth care. This recruitment will help me to pursue my career in Ireland.So i am looking forward for your response.


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Section H - Additional Information

Use this section to highlight any non-academic achievements, awards and any otheradditional information you think is relevant to your application.

4 weeks in Surgical Oncolgy from SHAUKAT KHANUM MEMORIAL CANCERHOSPITAL ,LAHORE in April 2009.

4 weeks in Cardiac Medicine& Cardiac Surgery from PAKISTAN INSTITUTE OFCARDIOLOGY, LAHORE in March 2009.

CONFERENCES / SYMPOSIUM / SEMINARS:

The 8th Shaukat Khanum Memorial Cancer Symposium held on February 26-28,2009by The American Academy of Continuing Medical Education.

3rd International Conference of Reproductive Health & ART held on February 6-8 ,2009.

4th Annual International Conference of Gastroenterology held on 29th January2009.


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Section I - Referees

Referee 1

Name : Dr Shahid Khatak

Title : General and Colorectal surgeon

Clinical Site : Shaukat Khanum Memorial CancerHospital & Research Center, Lahore,Pakistan

Address 1 : Shaukat Khanum Memorial CancerHospital & Research Center, Johar TownLahore, Pakistan


Phone : +923449825678

Fax :

E-Mail : [email protected]

Referee 2

Name : Dr Mohammad Salim Malik

Title : Gynaecologist

Clinical Site : Shaukat Khanum Memorial CancerHospital & Research Center, Lahore,Pakistan


Address 2 : Shaukat Khanum Memorial CancerHospital & Research Center, Johar Town

Lahore, Pakistan

Phone : +923334232125

Fax :


Referee 3

Name : Dr Ameer Afzal

Title : Assistant Professor,East surgical wardMayo Hospital, Lahore, Pakistan


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Clinical Site : Assistant Professor,East surgical wardMayo Hospital, Lahore, Pakistan

Address 1 : Assistant Professor,East surgical wardMayo Hospital, Lahore, Pakistan

Address 2 : Assistant Professor,East surgical ward

Mayo Hospital, Lahore, PakistanPhone : +923009460301

Fax :



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Section J - Notes

When your application form is received, we create a record in your name, which containsmuch of the personal information you have supplied. This personal record is used solely

in processing your candidature and should you be successful certain information youprovide will be forwarded to the employing organisation. Such information held is subjectto the rights and obligations set out in the Data Protection Acts, 1988 & 2003.

DATA PROTECTION ACTS 1988 & 2003Accepted?

Yes

Section K - Further documentation you could send on request

Please indicate what supporting documents you have which you could send on request

Certified copy of Medical Council Certificateof Registration or registration letter

Yes

Certified copy of transcript of exam resultsfrom your Medical School / University

Yes

Certified copy of other degrees / diplomas (ifapplicable)

Yes

Others Yes

Please specify Conferences and Elective documents,ACLS and Trauma course.

Section L - Signature

Name Dr Ch Muhammad Aqeel

Date 04/05/2012


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Section M Part 1 - Declarations

Declaration One - Garda/Police

Can you declare that you have not at any time been convicted (i.e. probation, fine, sentence,penalty) of a criminal offence (e.g. assault, public order, sexual assault) in the Republic ofIreland and/or in any other jurisdiction nor are there any charges relating to criminal offencesoutstanding or pending; that you have never been the subject of a Caution or Bound overorder?

Yes


Date 04/05/2012

Declaration Two - Training Organisation / Programme

Can you declare that you are currently not nor were you the subject of an investigation byany professional medical training body or its equivalent in the Republic of Ireland and/or inany other jurisdiction?

Yes


Date 04/05/2012

Declaration Three - Medical Council / Licensing Body

Can you declare that you have not at any time been convicted (i.e. probation, fine, sentence,penalty) of a criminal offence (e.g. assault, public order, sexual assault) in the Republic ofIreland and/or in any other jurisdiction nor are there any charges relating to criminal offences

outstanding or pending; that you have never been the subject of a Caution or Bound overorder?

Yes


Date 04/05/2012


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Section M Part 2 - General Declarations


Date 04/05/2012


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Section A - Hospital Group = Hospital / Mental Health Service(Ticked on Original Application Form)


024279809 NCHD Application

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