Application Form For Registration In The Register Of Medical Practitioners Form - 2015 Page 11
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1611. DECLARATION (THIS DECLARATION MUST BE SIGNED BY ALL APPLICANTS)
:
C
E
O
,
TO
THE
HIEF
XECUTIVE
FFICER
MEDICAL COUNCIL
:-
I HEREBY DECLARE AND NOTE THAT
(a)
the information contained in this form and all documentation* provided in support of my
application is true and accurate to the best of my knowledge and belief and I have signed
this form in my own handwriting;
(b)
I have read and noted carefully the Medical Council’s Registration Rules 2011 and the
current Guide to the Application Procedure and Registration Rules;
I have read and understood the current edition of the Medical Council’s Guide to
(c)
Professional Conduct and Ethics;
(d)
I undertake to comply with paragraph 50.1 of the Medical Council’s Guide to Professional
Conduct and Ethics (see overleaf) regarding professional indemnity cover;
(e)
I hereby acknowledge and accept that failure by me to enclose all documents required by
the Medical Council will result in my application being declared invalid and the Level 1
document examination fee being forfeited;
I possess the skills to communicate effectively with patients and colleagues in the Republic
(f)
of Ireland.
*IMPORTANT* Under EU freedom of movement legislation, the Medical
Council is not entitled to require evidence of English language proficiency from EU citizens.
The Medical Council strongly urges that all applicants for whom English is not their first
language should attempt the IELTS to ensure that they have sufficient language skills to
practise medicine in Ireland.
Applicants should note that they may be required by
employers or agencies to meet certain English language requirements. Paragraph 12.1 of
the Medical Council’s Guide to Professional Conduct and Ethics states: “if you do not have
the professional or language skills...you must refer the patient to a colleague who can
meet those requirements.” It may be considered professional misconduct if a medical
practitioner is unable to communicate effectively with their patients and colleagues. See
overleaf for examples of evidence of communication skills.
(g)
I am familiar with the legislation appertaining to the practice of medicine in the Republic of
Ireland;
I am willing to attend the Medical Council’s offices to be interviewed in relation to this
(h)
application, if required;
(i)
I have not been suspended, erased or prohibited from practising medicine, or from being
registered as a medical practitioner in any country and, to the best of my knowledge, there
is no inquiry or disciplinary proceedings in being or contemplated against me in any
country, unless otherwise indicated in Q.8 of Section 8 of this application form;
(j)
I know of no reason why the Medical Council should not grant me registration in the
Register of Medical Practitioners in accordance with the provisions of the Medical
Practitioners Act 2007, as amended by the Health (Miscellaneous Provisions) Act 2007;
I acknowledge that the granting of registration is at the discretion of the Medical Council
(k)
under the provisions of the Medical Practitioners Act 2007 and the Registration Rules 2011;
(l)
I hereby consent and give authority to the Medical Council to make any enquiry with any
body or person in pursuance of my application for registration;
(m)
I understand that canvassing of Council Members, training bodies, referees or any other
party in relation to my application is prohibited. I acknowledge that canvassing will not
assist my application and could be deemed inappropriate. I accept that reports of
canvassing will be notified to the Medical Council.
(n)
I have read and understood the statutory provisions under section 41 subsections (1), (2),
(3), (4) and (5) and section 55(1) and (3) of the Medical Practitioners Act 2007 overleaf.
*Under current Medical Council policy, if an applicant provides any documentation in support of an
application for registration which is later found to be a forgery, the applicant will be refused
registration.
:
DATE:
SIGNATURE OF APPLICANT
_______________________________
________________
VERSION 8.0 - T
2015
HIS FORM WAS LAST UPDATED IN AUGUST
Page 11 of 16
-
-
PLEASE ENSURE YOU COMPLETE THE MOST UP
TO
DATE FORM AVAILABLE ON OUR WEBSITE
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