Name
*
First Name
Last Name
Date of Birth
*
MM
DD
YYYY
Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Email
*
Phone Number
*
Employer/Business Name
*
Nature of Business
*
Employer Contact Name
*
First Name
Last Name
Employer/ Business Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Employer Phone
*
(###)
###
####
Employer Email
*
VetSkill Approved Educational Institution
*
Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Phone Number
*
Student Number
*
Programme Tutor
*
SQP Type
*
Please tick one or more boxes to confirm which category or combination of categories you studied.
I confirm:
*
All SQPs joining the VetSkill Register must accept the following points:
a) To the best of my knowledge the details on this form are correct
b) I have provided my up to date personal contact details
c) I have provided my current employer contact details
d) I understand that it is my professional responsibility as an SQP to notify VetSkill of any change to my personal or employer details including: name, address, or contact details
e) I have confirmed the SQP type I hold from the list above
f) I have undertaken and passed the SQP re-instatement examination, if applicable
g) I have made a BACS Transfer or sent a cheque for the enrolment fee payable, if applicable
h) I am required to pay the annual re-accreditation fee no later than 31st December in order to remain on the SQP Register for the following year
i) I have declared if any professional organisation ever previously removed me from its register or refused to register me
j) I have declared any reason why I cannot continue my SQP duties during the next registration period
k) I understand that I am required to undertake mandatory CPD as set out by VetSkill in order to remain on the SQP Register.
l) I understand that VetSkill may share my CPD information with my Employer or other regulatory bodies
Do you have any conviction or caution for a criminal offence, binding over, conditional discharge or report to the Procurator Fiscal, with the exception of 'spent' convictions under the Rehabilitation of Offenders Act 1974, and fixed penalty motoring offences?
*
No
Yes
