Certificate of Eligibility (CEL) registration form

Registration form for Certificate of Eligibility (CEL) for short-term locums

An NHS certificate of eligibility for locums in O&G will be a pre-requisite for employment of short-term locums for tier 2nd and 3rd on call rotas (2 weeks or less) from February 2023.

For full details, see Certificate of Eligibility for short-term locums (CEL)

Personal details

First name/s *

Last name/s *

Email address *

RCOG account number

GMC number

Do you have RCOG membership or are you on the RCOG trainee register?

Yes - RCOG membership
Yes - Trainee register
No

Do you have an educational supervisor? If yes, please enter their full name here

Work details

Deanery

Grade of post

Start date of post

Day: Month: Year:

Name of most recent hospital worked at

Hospital address

Do you already have access to the RCOG Training ePortfolio?

Yes
No

Please select the certificate level you are applying for:

ST3 to ST5
ST6 to ST7

Disclaimer

Your information on the CEL register *

Tick to accept terms and conditions *