Expert witnesses Application Form

Introduction

Thank you for applying to be registered on the SCoR "Expert Witness" List. Please have the following information to hand to complete this application:
• Workplace details;
• Details of any current registration, and
• Qualification details.

It may not be possible to save a draft version and the form will need to be completed at one attempt. If constrained by time please submit essential contact details and provide as much information as you can. We will make contact with you if the form is incomplete and discuss best routes to completion.

GDPR Statement
We, the Society and College of Radiographers (SCoR), ask for the details in this online form to administer and manage the registrant's inclusion on the "Expert Witness" List. Your name, contact email and areas of expertise will be shared, when appropriate, with those who contact the SCoR and who are in need of an "Expert Witness." In addition, your personal details will be held on servers hosted and secured by third parties on behalf of SCoR.
Our lawful basis for processing your information is to manage your registration and fulfil our legitimate interest as a professional body. We will retain all information you submit for the duration of your membership of the Society of Radiographers.

For detailed information about how we use your information please see http://www.sor.org/privacy-statement.
By completing this online form you are giving your consent for the personal data you provide to be processed by the SCoR, and other individuals or organisations required to process your request.

Section A - Personal Details

First Name

Surname/Family Name

Date of Birth

Contact Address (home)

Postcode

Telephone Number (home)

Telephone Number (mobile)

Preferred Email address

Professional Background (if Other)

Job Title (including grade)

Organisation

Please state if independent practitioner or company director

Address (workplace)

Telephone Number (workplace)

Please provide details of other posts held and employers

Society and College of Radiographers Membership Number

Section B - Current registration details

Are you currently registered on a statutory register?

Yes No

Are you currently registered on either of the following statutory registers?

HCPC

NMC

Please use digits only!

When inputting your Registration Number, please use digits only!
For example if your registration number is RA12345, please just type 12345.

Registration number (if applicable)

Registration start date (if applicable)

Registration expiry date (if applicable)

If not statutorily registered, are you registered with the Register of Clinical Technologists or other voluntary register?

Yes No

Are you registered with any other Voluntary Register? (please specify)

Section C - Professional Expertise

Qualifications (Date, University or College, type and name of award)

Postgraduate education

Certificates (e.g. IV injection)

Please provide brief details of career history (up to 500 words)

Publications/Research

Please state areas of practice as an "Expert Witness"

Please state areas of practise that you would consider yourself to be an "Expert Witness" and in which you would be prepared to act if contacted by solicitors acting for the plaintiff or defence in a civil action.

Details of any "Expert Witness" or similar training received

Brief summary of any work performed as an "Expert Witness"

Specific case details are not necessary.

Please give any other information that you consider to be relevant to support your application

Do you hold SCoR accreditation as a Consultant Practitioner?

Yes No

Do you hold SCoR accreditation as an Advanced Practitioner?

Yes No

References - We do not require any references at this stage. If subsequently needed we will contact you to identify references and obtain permission to contact them

We, the Society and College of Radiographers (SCoR), ask for the details in this online form to administer and manage the registrant's inclusion on the "Expert Witness" List. Your name, contact email and areas of expertise will be shared, when appropriate, with those who contact the SCoR and who are in need of an "Expert Witness." In addition, your personal details will be held on servers hosted and secured by third parties on behalf of SCoR. Our lawful basis for processing your information is to manage your registration and fulfil our legitimate interest as a professional body. We will retain the information you submit for the duration of your membership of the Society of Radiographers. For detailed information about how we use your information please see http://www.sor.org/privacy-statement. If you have any questions about Our use of your personal data, please contact the Data Protection Officer (DPO) at [email protected]. If at any point you have concerns about Our handling of your personal data, please contact the Information Commissioner's Officer (ICO) using their website www.ico.org.uk.

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Expert witnesses Application Form

Please use digits only!

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