Faculty of Advancing the science and practice

Pharmaceutical of pharmaceutical medicine for the

benefit of the public
Medicine
A: 19 Angel Gate, 326a City Road, London, EC1V 2PT | T: +44(0) 20 3696 9044
W: fpm.org.uk | E: fpm@fpm.org.uk

DIPLOMA IN HUMAN PHARMACOLOGY

Curriculum Vitae Template

Complete this form and email a copy to exams@fpm.org.uk or post to the address above.
You may add or remove boxes as relevant to your experience.

PERSONAL DETAILS
Title First name Surname

Address for correspondence

Phone number

Email
FPM membership No. (if
applicable)
Date of birth (dd mm yy)

MEDICAL REGISTRATION
GMC (UK) No. Date:
No. Date: Country:
Medical Reg. (non-UK)

1
ACADEMIC RECORD
From To
Qualification Institution / Awarding Body
mm/yy mm/yy

PROFESSIONAL AFFILIATIONS/MEMBERSHIP OF LEARNED

SOCIETIES (if relevant)

DETAILS OF EXPERIENCE IN HUMAN PHARMACOLOGY /

TRANSLATIONAL MEDICINE e.g. time spent and types of studies in which you
have been actively involved and in what capacity

2
EMPLOYMENT HISTORY
NB: You must state periods of absence e.g. sickness, parental leave longer than one month.

PHARMACEUTICAL
Present or most recent
Company / Institution: Address of company / institution:

From (mm/yy): To (mm/yy):

Job Title: Postcode:

Responsibilities:

Previous
Company / Institution: Address of company / institution:

From (mm/yy): To (mm/yy):

Job Title: Postcode:

Responsibilities:

Previous
Company / Institution: Address of company / institution:

From (mm/yy): To (mm/yy):

Job Title: Postcode:

Responsibilities:

Previous
Company / Institution: Address of company / institution:

From (mm/yy): To (mm/yy):

Job Title: Postcode:

Responsibilities:

CLINICAL
3
Present or most recent
From To Full time or
Institution Job title
mm/yy mm/yy Sessions/wk

Supervisors e.g. Consultants

Continuing Care

Emergency take & frequency

Specific procedures learned

Outpatient / Specialty Clinics

Experience of prescribing

Previous
From To Full time or
Institution Job title
mm/yy mm/yy Sessions/wk

Supervisors e.g. Consultants

Continuing Care

Emergency take & frequency

Specific procedures learned

Outpatient / Specialty Clinics

Experience of prescribing

4
Previous
From To Full time or
Institution Job title
mm/yy mm/yy Sessions/wk

Supervisors e.g. Consultants

Continuing Care

Emergency take & frequency

Specific procedures learned

Outpatient / Specialty Clinics

Experience of prescribing

Previous
From To Full time or
Institution Job title
mm/yy mm/yy Sessions/wk

Supervisors e.g. Consultants

Continuing Care

Emergency take & frequency

Specific procedures learned

Outpatient / Specialty Clinics

Experience of prescribing

5
Previous
From To Full time or
Institution Job title
mm/yy mm/yy Sessions/wk

Supervisors e.g. Consultants

Continuing Care

Emergency take & frequency

Specific procedures learned

Outpatient / Specialty Clinics

Experience of prescribing

Additional / Non-training posts (if relevant)

From To Full time or
Institution Job title
mm/yy mm/yy Sessions/wk

Responsibilities:

TEACHING EXPERIENCE (if relevant)

PUBLICATIONS (if relevant)

OTHER INFORMATION (if relevant)