Common use of Agreement Application Clause in Contracts

Agreement Application. RCSLT Membership for SLTs coming to the UK from Ireland, USA, New Zealand, Australia or Canada. Applicants must complete a membership declaration by signing up to the following statements in the space provided. These are requirements in the RCSLT Memorandum and Articles of Association. Change of personal details: Declarations:  I declare my adherence to the published Code of Ethics and Professional Conduct (See Communicating Quality (3), Professional standards for speech and language therapists)  I declare my commitment to maintaining my competence and expertise through active engagement in a range of professional activities, events and continuing education and agree to engage in a programme of continuing professional development of which I am keeping an up-to-date record.  I declare my understanding that if I practice in the United Kingdom. I must be registered with the Health and Care Professions Council. Signed: ........................................... Print name: ............................................ Date: ............................................... Membership no: RC00: ......................... SE1 1NX Or ▇▇▇▇▇▇▇▇▇▇@▇▇▇▇▇.▇▇▇ Or by email, at: ▇▇▇▇▇▇▇▇▇▇@▇▇▇▇▇.▇▇▇ Forename: ...................................... Surname: ................................................ Mr  Mrs  Ms  Miss  Other  Please state: .................................. Date of birth:: .................................. Telephone: .............................................. My new address is:............................................................................................ ........................................................................................................................... ........................................................................................................................... ........................................................................ Postcode: ................................. ........................................................................ Year of qualification: ................. Account no:..................................... Sort code: ................................................ Title of qualification: ........................................................................................... Education establishment, city and country: ....................................................... ........................................................................................................................... Current professional association: ...................................................................... Your membership number for your current professional registration:................ the RCSLT Declarations and statements: I consent to (insert name of home association) ........................................................................................................................... sharing with the Royal College of Speech and Language Therapists all information regarding any investigations and pending charges, convictions cautions and any other disciplinary actions against me, including any that may arise subsequent to this application. Are you applying for certification under the Mutual Recognition of Credentials Agreement to any of the other signatory associations? SE1 1NX Or ▇▇▇▇▇▇▇▇▇▇@▇▇▇▇▇.▇▇▇ Or by email, at: ▇▇▇▇▇▇▇▇▇▇@▇▇▇▇▇.▇▇▇ No Yes If so, which association? ........................................................................................................................... Have you applied for certification under the Mutual Recognition of Credentials Agreement associations in the past and been rejected? No Yes I agree that the results of my application may be shared with the other signatory associations to the agreement for research purposes. No identifying information will be included with this information. Have you ever been investigated, or subject to censure or prosecution, in a civil or criminal context (if so, please supply details of the investigation and its outcome): Language Proficiency Which do you regard as your first language? …………………………… If English is not your first language, please provide documentary evidence of a pass on the International English Language Testing System [IELTS] of grade 8 or above, with no section less than 7.5 Have you ever been subject of an investigation concerning professional misconduct, or professional incompetence or incapacity? If the answer to this question is ‘yes’, please provide details, and provide information about the outcome and any disciplinary action taken against you: Signed: .............................................................................................................. Print name: ....................................................................................................... SE1 1NX Or ▇▇▇▇▇▇▇▇▇▇@▇▇▇▇▇.▇▇▇ Or by email, at: ▇▇▇▇▇▇▇▇▇▇@▇▇▇▇▇.▇▇▇

Appears in 1 contract

Sources: Mutual Recognition Agreement Application

Agreement Application. RCSLT Membership for SLTs coming to the UK from Ireland, USA, New Zealand, Australia or Canada. Applicants must complete a membership declaration by signing up to the following statements in the space provided. These are requirements in the RCSLT Memorandum and Articles of Association. Change of personal details: Declarations:  I declare my adherence to the published Code of Ethics and Professional Conduct (See Communicating Quality (3), Professional standards for speech and language therapists)  I declare my commitment to maintaining my competence and expertise through active engagement in a range of professional activities, events and continuing education and agree to engage in a programme of continuing professional development of which I am keeping an up-to-date record.  I declare my understanding that if I practice in the United Kingdom. I must be registered with the Health and Care Professions Council. Signed: ........................................... Print name: ............................................ Date: ............................................... Membership noHCPC No: RC00: ......................... ............................................. SE1 1NX Or ▇▇▇▇▇▇▇▇▇▇@▇▇▇▇▇.▇▇▇ Or by email, at: ▇▇▇▇▇▇▇▇▇▇@▇▇▇▇▇.▇▇▇ Forename: ...................................... Surname: ................................................ Mr  Mrs  Ms  Miss  Other  Please state: .................................. Date of birth:: .................................. Telephone: .............................................. My new address is:............................................................................................ ........................................................................................................................... ........................................................................................................................... ........................................................................ Postcode: ................................. ........................................................................ Year of qualification: ................. Account no:..................................... Sort code: ................................................ Title of qualification: ........................................................................................... Education establishment, city and country: ....................................................... ........................................................................................................................... Current professional association: ...................................................................... Your membership number for your current professional registration:................ the RCSLT Declarations and statements: I consent to (insert name of home association) ........................................................................................................................... sharing with the Royal College of Speech and Language Therapists all information regarding any investigations and pending charges, convictions cautions and any other disciplinary actions against me, including any that may arise subsequent to this application. Are you applying for certification under the Mutual Recognition of Credentials Agreement to any of the other signatory associations? SE1 1NX Or ▇▇▇▇▇▇▇▇▇▇@▇▇▇▇▇.▇▇▇ Or by email, at: ▇▇▇▇▇▇▇▇▇▇@▇▇▇▇▇.▇▇▇ No Yes If so, which association? ........................................................................................................................... Have you applied for certification under the Mutual Recognition of Credentials Agreement associations in the past and been rejected? No Yes I agree that the results of my application may be shared with the other signatory associations to the agreement for research purposes. No identifying information will be included with this information. Have you ever been investigated, or subject to censure or prosecution, in a civil or criminal context (if so, please supply details of the investigation and its outcome): Language Proficiency Which do you regard as your first language? …………………………… If English is not your first language, please provide documentary evidence of a pass on the International English Language Testing System [IELTS] of grade 8 or above, with no section less than 7.5 Have you ever been subject of an investigation concerning professional misconduct, or professional incompetence or incapacity? If the answer to this question is ‘yes’, please provide details, and provide information about the outcome and any disciplinary action taken against you: Signed: .............................................................................................................. Print name: ....................................................................................................... SE1 1NX Or ▇▇▇▇▇▇▇▇▇▇@▇▇▇▇▇.▇▇▇ Or by email, at: ▇▇▇▇▇▇▇▇▇▇@▇▇▇▇▇.▇▇▇

Appears in 1 contract

Sources: Mutual Recognition Agreement Application

Agreement Application. RCSLT Membership for SLTs coming to the UK from Ireland, USA, New Zealand, Australia or Canada. Applicants must complete a membership declaration by signing up to the following statements in the space provided. These are requirements in the RCSLT Memorandum and Articles of Association. Change of personal details: Declarations:  I declare my adherence to the published Code of Ethics and Professional Conduct (See Communicating Quality (3), Professional standards for speech and language therapists)  I declare my commitment to maintaining my competence and expertise through active engagement in a range of professional activities, events and continuing education and agree to engage in a programme of continuing professional development of which I am keeping an up-to-date record.  I declare my understanding that if I practice in the United Kingdom. I must be registered with the Health and Care Professions Council. Signed: ........................................... Print name: ............................................ Date: ............................................... Membership no: RC00: ......................... SE1 1NX Or ▇▇▇▇▇▇▇▇▇▇@▇▇▇▇▇.▇▇▇ Or by email, at: ▇▇▇▇▇▇▇▇▇▇@▇▇▇▇▇.▇▇▇ Forename: ...................................... Surname: ................................................ Mr  Mrs  Ms  Miss  Other  Please state: .................................. Date of birth:: .................................. Telephone: .............................................. My new address is:............................................................................................ ........................................................................................................................... ........................................................................................................................... ........................................................................ Postcode: ................................. ........................................................................ Year of qualification: ................. Account no:..................................... Sort code: ................................................ Title of qualification: ........................................................................................... Education establishment, city and country: ....................................................... ........................................................................................................................... Current professional association: ...................................................................... Your membership number for your current professional registration:................ the RCSLT Declarations and statements: I consent to (insert name of home association) ........................................................................................................................... sharing with the Royal College of Speech and Language Therapists all information regarding any investigations and pending charges, convictions cautions and any other disciplinary actions against me, including any that may arise subsequent to this application. Are you applying for certification under the Mutual Recognition of Credentials Agreement to any of the other signatory associations? SE1 1NX Or ▇▇▇▇▇▇▇▇▇▇@▇▇▇▇▇.▇▇▇ Or by email, at: ▇▇▇▇▇▇▇▇▇▇@▇▇▇▇▇.▇▇▇ No Yes If so, which association? ........................................................................................................................... Have you applied for certification under the Mutual Recognition of Credentials Agreement associations in the past and been rejected? No Yes I agree that the results of my application may be shared with the other signatory associations to the agreement for research purposes. No identifying information will be included with this information. Have you ever been investigated, or subject to censure or prosecution, in a civil or criminal context (if so, please supply details of the investigation and its outcome): SE1 1NX Or ▇▇▇▇▇▇▇▇▇▇@▇▇▇▇▇.▇▇▇ Or by email, at: ▇▇▇▇▇▇▇▇▇▇@▇▇▇▇▇.▇▇▇ Language Proficiency Which do you regard as your first language? …………………………… If English is not your first language, please provide documentary evidence of a pass on the International English Language Testing System [IELTS] of grade 8 or above, with no section less than 7.5 Have you ever been subject of an investigation concerning professional misconduct, or professional incompetence or incapacity? If the answer to this question is ‘yes’, please provide details, and provide information about the outcome and any disciplinary action taken against you: Signed: .............................................................................................................. Print name: ....................................................................................................... SE1 1NX Or ▇▇▇▇▇▇▇▇▇▇@▇▇▇▇▇.▇▇▇ Or by email, at: ▇▇▇▇▇▇▇▇▇▇@▇▇▇▇▇.▇▇▇

Appears in 1 contract

Sources: Mutual Recognition Agreement Application