Fillable Application for registration International (The Health and Care Professions Council)

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Application for registration International (The Health and Care Professions Council)

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Page 1
This application is for registration in the following part of the HCPC Register:
Please read the International – application for registration guidance document before completing this form.
Please read the standards of proficiency relevant to your profession.
PLEASE NOTE: the HCPC will only retain an electronic copy of your application. The paper version of an application and any
supporting documents are destroyed once it has been processed. Original documents should not be included with your application
and the HCPC accepts no responsibility for the destruction of any original documents which are submitted as part of an application.
Application for registration – International
For help or enquiries: Registration Department,
Park House, 184-186 Kennington Park Road, London, SE11 4BU
+44 (0)300 500 4472 international@hcpc-uk.org
Important: Have you previously applied for registration with the HCPC or the Health Professions Council (HPC)?
Yes No
If yes, please give your application number
Part 1 Arts therapist
Part 2 Chiropodist / podiatrist
Part 3 Clinical scientist
Part 4 Dietitian
Part 5
Biomedical scientist
Part 6 Occupational therapist
Part 7 Orthoptist
Part 8 Paramedic
Part 9 Physiotherapist
Part 10 Prosthetist / orthotist
Part 11 Radiographer
Part 12 Speech and language therapist
Part 13 Operating department practitioner
Part 14 Practitioner psychologist
Part 15 Hearing aid dispenser
INTAPP04/Aug/2021
© Health and Care Professions Council 2021
Reset form
Page 2
For HCPC use only: Profession AA number
SECTION 1 – Your details
Please tell us more about you:
Mr Mrs Miss Ms
Other
(please specify)
Title
F
irst name
Last name
Previous name(s)
Nationality
Date of birth
Town / city of birth
Country of birth
Sex
Male Female
National insurance number (NIN)
Please provide your current address:
House / flat number
Street name
Town / city
County / state
Postcode / zipcode
Country
Telephone (including international dialling code) +
Mobile
(including international dialling code) +
Email
Evidence required: Please provide a certified proof of your identity and of your current address.
Email addresses are mandatory as we require this information for you to set up an HCPC account.
By providing my email address I consent to the HCPC sending me electronic communications for the purposes set
out in the HCPC subject informatio
n statement which can be found at https://www.hcpc-uk.org/apply/personaldata/
Click to attach a
recent passport style
photograph.
OR glue photograph
once this form is
printed. Do not staple.
Please refer to
guidance notes.
35mm or 415 pixels
45mm or 535 pixels
Add another
Day
Month
Year
SECTION 2 – Qualification in relevant profession
P
l
ease tell us more about your qualification in the relevant profession:
Name of qualification
(in its original language)
Name of qualification
(in English)
Qualification start date Date qualification was awarded
Have you provided the course information form? Yes No
Name and address of
educational institution
Please provide official contact details for the course administrator.
Name and job title
Email
Please list any additional formal qualifications you hold (do not include short courses,
eg day courses):
Name of qualification
(in its original language)
Name of qualification
(in English)
Qualification start date Date qualification was awarded
Have you provided the course information form? Yes No
Name and address of
educational institution
Please provide official contact details for the course administrator.
Name and job title
Email
Name of qualification
(in its original language)
Name of qualification
(in English)
Qualification start date Date qualification was awarded
Have you provided the course information form? Yes No
Name and address of
educational institution
Please provide official contact details for the course administrator.
Name and job title
Email
Evidence required: Please provide certified copies and translations of these qualifications.
Please provide additional details regarding the content and duration of your training. You must provide a completed Course
information form which you may download from our website. This form must be completed and certified by the awarding
institution. The Course information form needs to set out a detailed description of the content of the modules and subjects studied,
as well as any practical experience gained during the course.
P
age
3
For HCPC use only: Profession
AA number
Day
Month
Year
Day
Month
Year
Day
Month
Year
Day
Month
Year
Day
Month
Year
Day
Month
Year
Page 4
For HCPC use only: Profession AA number
SECTION 3 – Professional experience
Form no. 1
Tell us more about your professional experience, including internships, below.
We will contact chosen employers/supervisors to confirm the information you provide.
Please only give details of posts relevant to your profession.
Please note: If you have not practised since qualifying, please give details of any placements undertaken while studying for your
qualification.
Name of employer / organisation
Employer’s address
Telephone (including international dialling code) +
Email
Contact name
(e.g. supervisor / manager)
Start date
End date
present day
Hours per week
Position held (in original language)
Position held (in English)
Were you registered with a regulatory or professional body whilst in this post? Yes No
Please provide more details of this post, taking into account the key competencies for the practise of your profession.
• Please describe the work setting(s) and provide a summary of the range of service users you dealt with (and the type of
services provided).
• Please tell us about the types of assessment, treatment and evaluation methods used.
We encourage you to provide additional information from your employer / supervisor separately to supplement
the details provided in this section.
Continued over page
If yes please give details:
Name of organisation
Contact email / website
Day
Month
Year
Day
Month
Year
Page 5
For HCPC use only: Profession
AA number
Continued from previous page
Page 6
For HCPC use only: Profession
AA number
Form no. 2
Tell us more about your professional experience, including internships, below.
We will contact chosen employers/supervisors to confirm the information you provide.
Please only give details of posts relevant to your profession.
Please note: If you have not practised since qualifying, please give details of any placements undertaken while studying for your
qualification.
Name of employer / organisation
Employer’s address
Telephone (including international dialling code) +
Email
Contact name
(e.g. supervisor / manager)
Start date
End date
present day
Hours per week
Position held (in original language)
Position held (in English)
Were you registered with a regulatory or professional body whilst in this post? Yes No
Please provide more details of this post, taking into account the key competencies for the practise of your profession.
• Please describe the work setting(s) and provide a summary of the range of service users you dealt with (and the type of
services provided).
• Please tell us about the types of assessment, treatment and evaluation methods used.
We encourage you to provide additional information from your employer / supervisor separately to supplement
the details provided in this section.
Continued over page
If yes please give details:
Name of organisation
Contact email / website
Day
Month
Year
Day
Month
Year
Page 7
For HCPC use only: Profession
AA number
Continued from previous page
Page 8
For HCPC use only: Profession AA number
SECTION 4 – Professional registration and membership
to
present day
Name of organisation (in original language)
Name of organisation (in English)
Registration number
Date registered from
Email
Website
Telephone (including international dialling code) +
to
present day
Name of organisation (in original language)
Name of organisation (in English)
Registration number
Date registered from
Email
Website
Telephone (including international dialling code) +
to
present day
Name of organisation (in original language)
Name of organisation (in English)
Registration number
Date registered from
Email
Website
Telephone (including international dialling code) +
Please list in chronological order all regulatory or professional bodies with which you
have been registered or of which you have been a member:
to
present day
Name of organisation (in original language)
Name of organisation (in English)
Registration number
Date registered from
Email
Website
Telephone (including international dialling code) +
Day
Month
Year
Day
Month
Year
Day
Month
Year
Day
Month
Year
Day
Month
Year
Day
Month
Year
Day
Month
Year
Day
Month
Year
Page 9
For HCPC use only: Profession AA number
SECTION 5 – English language proficiency
Please refer to the standards of proficency. Every registrant must ensure that they can communicate effectively with patients,
clients, users, carers and other professionals.
Is English your first language? You should only indicate that English is your first language if it is the main or only
language you use on a day-to-day basis. Having studied English or undertaken education or training at an institution where
the medium of instruction is English does not necessarily mean that English is your first language.
Yes No
If no, you must provide proof of your English proficiency. Please refer to guidance notes for details of recognised language tests and
the minimum acceptable scores.
English Language test taken:
If Other is selected, please provide the name of the test:
Scores for: Listening
Reading
Writing
Speaking
Applicants whose first language is not English and who are required to provide a language test certificate as evidence of their
proficiency must ensure that it is, or is comparable to, IELTS level 7.0 with no element below 6.5 (or IELTS level 8.0 with no element
below 7.5 for Speech and language therapists). If you propose to rely upon a non-IELTS test score that is not listed below, it will be
your responsibility to provide evidence that it is comparable to the requisite IELTS levels. Failure to do so will delay the processing of
your application.
** We cannot accept any TOEFL test score undertaken in the United Kingdom.
SECTION 6 – Paying your scrutiny fee
It is a requirement that you provide an email address so that we can notify you when payment is required.
Payment for this application only – When we start processing your application, you will receive an email with a link to
WorldPay payment service.
Please follow the link to make your payment; the link will remain active for 72 hours. If you do not access the link and make
payment within this time, you will need to call us to make a debit / credit card payment. This will delay the application
process as we cannot process your application without a payment.
Email
Please note: If you require the payment to be made by a third party, you can forward the payment link email to them once
received. They will be able to access the link and complete the payment on your behalf.
Page 10
For HCPC use only: Profession
AA number
SECTION 7 – Declarations
• I declare that I have read, understood and will comply with the HCPC’s standards of conduct, performance and ethics.
• I understand that I must have in place a professional indemnity arrangement which provides appropriate cover and I confirm
that I will have this in place when I practise.
• I
agree to pay the fees for my registration.
• I consent to the HCPC contacting any person to obtain further information about my application or to verify the information that
I have provided and agree that any person who is so contacted may provide the HCPC with an information about me which that
person holds.
• I confirm that the information I have provided in this application is correct and understand that fraudulently procuring an entry in
the HCPC Register is a criminal offence under article 39 of the Health Professions Order 2001.
Character and health/vetting and barring
Please read the accompanying guidance notes carefully before completing this section. If your answer to any of the questions
below is yes, please indicate by placing a cross in the appropriate box and give details on a separate sheet.
Yes No
Yes No
Yes No
Yes No
Have you been convicted of a criminal offence or received a police caution (other than a protected caution
or protected conviction)?
Have you been disciplined by a professional or regulatory body or your employer?
Have you had civil proceedings brought or any other claim made against you, your employer
or any indemnity insurer arising from the practise of your profession?
Do you have any physical or mental health condition that would impair your fitness to practise
your profession?
Are you or have you ever been barred under the Safeguarding Vulnerable Gr
oups Act 2006
Children Yes No
Vulnerable adults Yes No
Date
or the Protection of Vulnerable Groups (Scotland) Act 2007 from working with:
Signed
(Please sign after form is printed)
Name
Please read, complete and sign the below declarations:
Day
Month
Year
Page 11
For HCPC use only: Profession AA number
CHECKLIST
Before sending this form please ensure that:
you have read and understood the Standards of proficiency relevant to your profession
you have read and understood the Standards of conduct, performance and ethics
you have read the guidance notes to this application form
you have included the scrutiny fee payment email address
the copy of your ID is certified
the copy of proof of your address is certified
you have pr
ovided certified proof of any name change (if applicable)
a passport photo is attached
you have included a certified copy of your relevant qualification certificate and an official translation (where applicable)
you have provided the original and the certified translation of the Course information form
you have provided at least one completed form relating to your professional experience with contact details for
your supervisor (while studying or since graduating)
NOTE:
• Please do not staple any part of this application.
• Please do not send parts of this application in separate plastic wallets or covers.
• For confirmation of safe receipt it is advisable to send the application by registered mail, so you will be able to track it.
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Application for registration International (The Health and Care Professions Council)

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Completed 10 December 2021

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