Facilitated Placement Application Form
It is important to ensure that you have completed this form with the relevant specialty post /
programme information spreadsheet also found in the resource bank as this may assist with
selecting preferences
Name
Email address
Contact telephone number
GMC Number
Oriel PIN
Please provide details of the post that you have accepted:
Specialty
Level of training
Region
Offer detail
Please provide details of the placement/s that you wish to be considered for:
(if you wish to detail more than five preferences, please just add further boxes as only those
specifically listed will be considered)
Region
Where preferences for the specialty are made to a greater granularity e.g. specific
location, please state the preferences that you would wish to be swapped into
(available from the original application)
Preference 1
Preference 2
Preference 3
Preference 4
Preference 5

Please confirm which of the following categories you fit into:
Primary carer for someone who is disabled, as defined by the Equality Act 2010
Have a medical condition or disability for which ongoing follow up for the condition
in the specified location is an absolute requirement
In a committed relationship (e.g. husband, wife, boyfriend, girlfriend) with another
applicant in the application process
In a committed relationship (e.g. husband, wife, boyfriend, girlfriend) with another
doctor already in training
In a committed relationship (e.g. husband, wife, boyfriend, girlfriend) with an
individual currently not in medical training and not in the application process
Significant responsibilities to care for another person, whether solely or as part of
a group (e.g. family members), where these are not covered in any other category
Not covered by any of the above eligibility criteria
If you are in a committed relationship with another applicant to specialty
recruitment, are they also applying for a facilitated swap in this round?
Yes/ No/ N/A
If yes, please give details of your partner:
Name
Email address
Contact telephone number
GMC Number
Oriel PIN
Specialty applying for a swap in
The application window for facilitated placements for Round 1 Re-advert is 13 May, 9am to
19 May, 4pm. Please submit this form and any additional evidence during this window, via email to [email protected]
Applications will only be accepted during this window
For office use only:
Application ID No.
Linked to another application
If yes, Application ID No. for link
Application Category
Yes / No