Test Application Form – Application form for the NHS Leadership Academy's {programme-name} programme

Application Form – 2023

Test application form 2023

We would recommended you click ‘Save and Continue Later’ button to avoid your application being lost as you proceed through the questions.

1Privacy Agreement

2About you

3Cohort

4Employment Information

5Funding

6Equality, Diversity & Inclusion

7Personal Statement

8Keeping in touch

9Agreement

10Summary

Application-ID Optional

Hidden

Submission Date Optional

Privacy Agreement

Any information you provide in completing this application will be stored and processed in accordance with our Data Privacy Policy which you are required to read and accept before completing your application.

By proceeding with this application, you agree that The NHS Leadership Academy may contact you if you have partially completed your application to offer guidance and support with finishing your application.
This is a separate agreement to the marketing preferences selected further in this application.

Please check the box below to accept the above agreement and our Data Privacy Policy

I confirm I have read and accept the Academy’s Data Privacy Policy and above agreement

Please note this form is closed and applications will not be counted

About you

Name

First Last

Preferred Name Optional

Preferred Email

Your primary email address

Preferred contact number

Your main contact number with international dialling code and extension if necessary

Date of Birth Optional

Please enter your 10-digit Academy ID

If you already have an Academy ID, please log on to our new Academy Profile system using your existing log in details to ensure your account is transferred to our new system.

If you need help remembering your existing Academy ID, please use the Reset password feature on the Profile system.

If you do not have an Academy ID, please register on our Academy Profile system to create one.

Home address

Street Address Optional City Optional ZIP / Postal Code Optional Country Optional

Home Region

Employment Information

Please enter the details of your current main job role.

Organisation Region

Organisation Name

The name of your organisation

Primary Role The primary role of your organisation

Postcode

The postcode of your organisation

Is this an NHS organisation?

Yes

Country

Please select your country

Hidden

Organisation Optional

Hidden

Organisation Type Optional

Please enter the type of organisation

Hidden

New Organisation

Hidden section that is only shown when the organisation is unknown

Hidden

Organisation Name Optional

Please enter the name of the organisation

Hidden

Organisation Post Code Optional

Please enter the post code of the organisation

Hidden

Does this organisation provide any NHS-funded care?

Yes

Don’t know

Hidden

Role

Area of work

Job Title

Please enter your job title

Salary/Band

Current?

Yes

Are you currently active in this role? Please note: we only require past roles if you are unemployed.

Equality & Diversity

We hold the principles of equality and inclusion at the heart of everything we do and all that we stand for. Each programme is held to account for its inclusion practice through a review of anonymised statistics based on this data. Your equality and diversity data is not used to determine the success of your application. This data is stored securely in compliance with the General Data Protection Regulation (GDPR) 2016.

Which of the following best describes your gender?

Are you now or have you ever defined yourself as Trans?

Which of the following best describes your sexual orientation?

Which of the following best describes your ethnic background?

Which of the following best describes your religion or belief system?

Which of the following best describes your nationality?

Do you consider yourself to have a disability?

Many people do not consider themselves to be disabled. However under the Disability Discrimination Act 1995 and the Equality Act 2010, you are protected from discrimination if you have a physical or mental impairment or long term health condition, the effects are expected to last – or have lasted – for a year or longer and have a substantial impact on your ability to carry out day to day activities; or your day to day activities would be limited without medication, treatment or adjustments (for example the use of inhalers, physiotherapy, a hearing or visual aid or insulin). Taking this into account, do you consider yourself to have a disability?

About your disability Optional

Problems?

For technical support email support@leadershipacademy.nhs.uk
Otherwise call {contact-phone-number} or email {programme-email-address}

Application Form – 2023

Privacy Agreement

Please note this form is closed and applications will not be counted

About you

Employment Information

New Organisation

Funding

Equality & Diversity

Personal Statement

Personal Statement

Keeping in touch

Terms and Conditions

Summary

Problems?