Mentor - Expression of interest
Mentor - Expression of interest
1.
Full Name
2.
Email address
3.
What is your profession?
Advanced Practitioner
First Contact Practitioner
GP
GPN
Nurse
Nursing Associate
Paramedic
Pharmacist
Physician Associate
Practice manager
Other (please specify)
4.
Date you qualified:
5.
Which practice are you currently employed with?
6.
Type of employment
Locum
Long term locum
Out of hours
Partner
Permanent
Salaried
Other (please specify)
7.
Which borough are you currently working in?
Barnet
Camden
Enfield
Haringey
Islington
Interested in moving into NCL
Other (please specify)