KF TEST Member Application Form

Please ensure you read the information below, prior to completing this form.

This form is designed to allow those seeking to join the Faculty as Affiliates, Nurse Affiliates, Paramedic Affiliates, or Associates to provide sufficient information to allow the Membership and Fellowship Committee (MFC) to make an appropriate decision.

Information submitted via this form will be used to carry out any reasonable activity related to the administration of the FFLM Membership process and is held subject to relevant data protection legislation.

Failure to complete all sections may result in rejection of the application as the Faculty considers this information is essential to enable the MFC to determine whether to recommend to the Board that an individual should be invited to join the Faculty.

The MFC will assess the application based on the information within this form. Because of the innate variability of the structure and information contained within Curriculum Vitae (CV) the MFC will not consider them. Please DO NOT insert or attach CVs to this form.

Please consult the relevant Guidance document for full details but very briefly:

Affiliate (including Nurse & Paramedic Affiliates)
These are clinicians actively engaged with and working within the field of forensic and legal medicine (this may be full or part time). This would typically include clinicians working in police custody, sexual offence medicine, medico/dento legal advisors, and medically qualified coroners.

It would also include medical examiners and reviewers as well as court appointed, medically qualified members of a tribunal. For clarity this does not include clinicians who work as disability assessors, write medical reports for legal processes, or are asked to provide evidence or opinion as expert witnesses to a tribunal.

Associate
This is our broadest category of membership and is open to those with an interest in the educational aspects of Forensic and Legal Medicine, but are not eligible for Affiliate membership. Associate members typically include legal professionals, expert witnesses, or those simply with an interest in the work we do.

All applications are reviewed and assessed by the MFC who may take advice at their discretion. It is a thorough but confidential process based on submitted information only and which does not involve the candidates directly.

Following a decision by the MFC, representative of the MFC will write / email the applicant to inform them of the outcome. This outcome may include recommending that an applicant is more suited to an
alternative membership group than that applied for.
If the outcome is unfavourable the applicant may apply again. Please note unsuccessful applicants are not automatically reviewed by the Faculty and so the onus is strictly on an applicant to submit a new application form if they wish to be re-considered by the MFC.

Applications will be considered at the next appropriate meeting of the MFC. The closing dates for completed applications and the dates of the MFC meetings are available on the website.

Member application form - KF

2Applicant Details

3Declarations

Please select to confirm:*
- I have read and understand the above text (tick to confirm and continue)
Please select to confirm:*
- Please tick this box to confirm that you have read, understood and accepted our privacy policy

About you
Applicant Details
Name*
Title First Last
Date of Birth*
DD slash MM slash YYYY
Email*
Phone*
Category applied for*
Membership applied for*
Professional Registration Body (e.g. GMC, GDC, NMC, HCPC)*
Professional Registration Number (e.g. GMC, GDC, NMC, HCPC)*
Website to confirm professional registration*
Date Joined Registered Body*
DD slash MM slash YYYY
Area of Practice*
Address for Confidential Correspondence*
Street Address Address Line 2 City County Postcode
Fellowships/Memberships of other colleges or societies*
Honours, Degrees or Qualifications where relevant (including date awarded)*
Please add Qualification, Awarding Body and Date awarded
Have you previously passed any FFLM qualification*
If yes, which one/s:
Date of Exam
DD slash MM slash YYYY
Have you attended a CED or GFM training course*
If yes
Date of the course*
DD slash MM slash YYYY
Role 1
Title*
Employer*
Date started*
DD slash MM slash YYYY
Average Hours Per Week*
Role 2
Title
Employer
Date started
DD slash MM slash YYYY
Average Hours Per Week
Role 3
Title
Employer
Date started
DD slash MM slash YYYY
Average Hours Per Week

Reason for application*
Please provide a very brief outline of your reasons for wishing to join the FFLM (no more than 1800 characters)
Additional information
E.g. record here that you have passed the MFFLM, LFFLM, DLM or DipHFID examination. (no more than 1500 characters)
Please tick to confirm you have read and accepted the form of faith*
- I have read and accepted the Form of Faith
Declaration on Complaints
As part of the application you are asked to declare any pending or upheld formal complaints, disciplinary procedure, litigation or referrals to your regulatory bodies. Please tick yes or no below:
Complaint Declaration*
- Yes: I DO have outstanding or previously upheld complaints regarding litigation, disciplinary, professional conduct or performance to declare. Please provide details by emailing charlene.campbell@fflm.ac.uk
- No: I DO NOT have any pending complaints or upheld formal complaints to declare.
Complaint Details*
If this situation should change before the date of the MFC, I undertake to inform the Faculty promptly in writing
Declaration
I confirm that the details provided in this application are correct & that I have read, understood, and agree to the FFLM privacy policy. I also give permission for the Faculty to perform checks with my employers and/or my regulatory body for any outstanding performance issues likely to bring the Faculty into disrepute. Should I be invited to join the Faculty of Forensic and Legal Medicine I agree to uphold its values.
*
I agree to the declarations and to the privacy policy.
Date
DD slash MM slash YYYY
Comments
This field is for validation purposes and should be left unchanged.

KF TEST Member Application Form

Please ensure you read the information below, prior to completing this form.

Member application form - KF

About you

Applicant Details

Role 1

Role 2

Role 3

Declaration on Complaints

Declaration