Sponsorship Scheme application form

GMC sponsorship for International Medical Graduates

Personal details

First Name(s) ^* (required)

Last Name ^* (required)

date of birth (dd/mm/yyyy) ^* (required)

Home address ^* (required)

postcode ^* (required)

Country ^* (required)

Contact number ^* (required)

Email address ^* (required)

Specialty ^* (required)

Primary Medical Qualification ^* (required)

Postgraduate Qualification ^* (required)

EMPLOYMENT STATUS AND REFEREES

Current Job title ^* (required)

Current Hospital ^* (required)

Employment dates (DD/MM/YYYY):

From ^* (required)

To ^* (required)

Referee 1:

Referee 1 (Current Supervisor) Job title ^* (required)

Full name ^* (required)

From ^* (required)

To ^* (required)

Email address ^* (required)

Employment dates (DD/MM/YYYY):

Referee 2 Job Title ^* (required)

Full name ^* (required)

From ^* (required)

To ^* (required)

Email address ^* (required)

Referee 3 Job Title ^* (required)

Full name ^* (required)

Employment dates (DD/MM/YYYY):

From ^* (required)

To ^* (required)

Email address ^* (required)

IMGs who have not secured a post should select Pending Status. IMGs who have secured a post will need to select 'Full Sponsorship' and provide details of their post in the UK.

What type of Sponsorship are you applying for? ^* (required)

Title of Post

Trust