COVID Vaccination Centre - Clinical Volunteer Details

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Contact information and details. Chichester Alliance of Medical Practices

Thank You

Thank you for your interest in vaccinating at our clinics; Tangmere Village Hall PO20 2HS and The Selsey Centre PO20 0SE. In order for us to collate information please see below and then fill in the form as appropriate.
For our current wave we are discussing vaccinator roles with those who are currently employed and those who have been retired for less than 3 years. If you are retired, please indicate the date you retired on the form below.
If you are more than 3 years post retirement, we are unfortunately not able to progress at this time but you are very welcome to submit your details as our policy may change in the future.

Re-registration information for clinicians

If required, please visit the following sites for more information;
Doctors - https://www.gmc-uk.org/registration-and-licensing/guide-for-doctors-granted-temporary-registration/about-your-registration-and-licence-to-practise
Nurses - for registrations lapsed between 1 March 2015 & 30th Nov 2020
https://www.nmc.org.uk/news/coronavirus/temporary-registration/

Title

First Name *

Surname *

Email *

Phone number *

Profession

Professional Registration Number

If you are retired, please tell us when you retired.

YYYY

Have you had a clear DBS check within the last three years?

Yes

Not sure

Clear selection

If you had a DBS check within the last three years, what date was it issued?

YYYY

Which centre would you be willing to work at?

Please select one or both sites

Selsey Centre, Manor Road, Selsey, PO20 0SE

Tangmere Village Centre, Chichester PO20 2HS

How many shifts would you be able to offer on average per week? (8am - 1pm shift, or 1pm - 6pm shift)

Do you wish to volunteer or be paid?

I wish to volunteer

I would l like to be paid

Clear selection

Additional Comments

Thanks for your offer of support and for submitting your contact information. We aim to contact you with further details about how you can help within 7 working days. Please let us know any additional information that may be helpful.

Submit

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