Wales International Medical Fellowship 2019

APPLICATION FORM
Please email this application form
Please fill in the application form in black ink & block letters & CV to:
or electronically. Please supply a current CV with this form
In the subject field of your email, only write the name of Wales.mtijobs@gmail.com
the speciality you are applying for and nothing else.
For example, if you are applying for Orthopaedic Surgery,
only write Orthopaedic Surgery in the subject field.

APPLICATION FOR EMPLOYMENT WITH NHS WALES

Job Reference Number WAL.INT.FEL-19

Personal Details
Title Dr
Surname/Family Name Bhat

First Name
Jehangir
Allam
Middle Name
VIKAS HOSPITAL PVT LTD THANA ROAD
NAJAFGARH NEW DELHI 110043
Address
(Including Postcode/ Zip code)

Country INDIA

Home Telephone
+917033203315
Email Address
(Most communication will be via email. Please
provide an active email address which you check ajaalam333@gmail.com
regularly. You must notify us of any change)

Please indicate which specialty you would like work in

Please write your sub-specialty alongside the main specialty
Anaesthesiology 
Medicine 
General Surgery 
Orthopaedic Surgery 
Paediatrics 
Psychiatry 

Other _____________________

(we cannot assure vacancies in specialities other than the

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 Wales International Medical Fellowship 2019

abovementioned, but will try to find a placement subject to availability)

It is Essential for you to complete ALL sections of this application form

Do you currently have a visa or other leave to remain in the UK?  Yes  No
(You must live overseas at time of application and return home after training)

Do you have a an appropriate medical qualification acceptable to GMC Yes  No

Part 1 Royal College Exam of the relevant college  Yes  No

Do you have MD/MS/DNB or similar degree with 3 years PG  Yes  No

experience.
You may be eligible for a Clinical Fellow post at equivalent to CT level if
you do not have MD/MS and 3-4 years experience

 Yes  No
Have you passed the IELTS or attempted it. Please provide tour scores
Date obtained
……………….

If no, would you be prepared to take the IELTS exam immediately  Yes  No

 Yes  No
Do you have or have you previously attempted the PLAB I or II test? Date
PLEASE NOTE: Passing PLAB I or II is NOT considered a satisfactory alternative to IELTS obtained/attempted
……………….

Education & Professional Qualifications

Please list your qualifications from MBBS onwards in date order (with most recent first). All
information disclosed on this application will be subject to verification.
Subject/Qualification Place of Study Grade/result Year obtained
MBBS SKIMS Medical college 1 2008
Srinagar J&K India
Diploma in child health Govt. Medical college Not given 2013
Jammu J&K India
DNB Pediatrics Diplomate national Board Not given 2017
New Delhi

Relevant Training Courses Attended

Please list all courses you have attended over the last 5 years, in date order (up to 5 with
most relevant ones).
Year
Course Title Training Provider Duration
Completed

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Membership of Professional Bodies

Please provide details regarding any relevant professional registrations or memberships. This
information will be subject to a satisfactory check.

If you have answered ‘I have current UK professional registration relevant for this post’ or ‘I
have current UK professional registration and licence to practise for this post’, then please
enter the relevant details below.
UK /Indian Professional Membership or Membership Expiry/Renewal
Body Registration type Registration Number Date

Fitness to Practise

*Are you currently subject to a fitness to practise investigation and/or proceedings by a

regulatory or licensing body in the United Kingdom, or in any other country?
Yes  No
If you have answered ‘yes’ above, provide full details below. Continue on a separate page.

*Have you ever been removed from the register or have conditions or undertakings been
made on your registration by a fitness to practise committee, regulatory or licensing body in
the United Kingdom, or in any other country?
 Yes  No

If you have answered ‘yes’ above, please provide details below- continue on a separate page

*In your employment so far, have you had restrictions placed on your clinical practise?

 Yes  No

If yes, please provide details of any restrictions you may have. Continue on another page

Employment History

Please record below full details of all your continuous employment history, beginning with
your current or most recent employer and working backwards chronologically.

Current / Most Recent Employment (Reference always required)

Contract
Start Date End Date
Duration >2years
(05/2017) Till date
(months)
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Employer Name VIKAS HOSPITAL PVT LTD NAJAFGARH NEW DELHI

Full Postal Address VIKAS HOSPITAL PVT LTD NAJAFGARH NEW DELHI INDIA

Post/Zip Code 110043

Clinical Supervisor No
Email vhplteam@gmail.com Job Title Pediatric specialist
Your Job Title Telephone
Grade
Specialty Pediatrics Current Basic Salary 1 lakh INR
Sub-Specialty
Hospital/Base
(if applicable)
Reason for leaving
(if applicable)

Brief description of your duties and responsibilities

My job as a pediatric specialist here is to provide compassionate and nurturing care to children of all
ages, perform ongoing examinations and evaluations to assess patient growth and development while
treating children afflicted with minor illnesses and acute / chronic health problems. From recording
medical histories and documenting exam results to prescribing medications and treatments and
interpreting diagnostic tests are some basic responsibilities which I fulfil here.
I usually assistant junior staff in doing procedures like IV-line, umbilical line (arterial as well as venous)
placement, LP, subdural taps, ET intubation.
I have attended PALS and NALS training courses during my post graduate training so we try out best to
apply the same protocol when needed.
Here in our hospital we strictly follow evidence-based guidance and work on variety of research
projects.

Previous Employers starting from 1st year of Post graduation

Emp
loye
Employer 1 Employer 2 Employer 3 r4
Start Date May 2011 June 2013 May 2105
End Date May 2013 May 2015 May 2107
Govt medical
Employer/Hospital
college Jammu City Max Hospital Kurji Holy Family Hospital
address
J&K India Tohana Haryana India Patna Bihar
Name of Clinical
supervisor Dr Rekha Haresh Dr I.G. Aggarwal Dr Amit Mittal

dr.ijaggarwal@gmail.co
Email of clinical m
supervisor kkrhdang@gmail.com mittal.1.amit@gmail.com
Your job title & grade PG 1,2 Pediatric registrar Academic registrar
Pediatrics and Pediatrics and Pediatrics and
Speciality Neonatology Neonatology Neonatology
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Post graduate
students are
supposed to learn
basic history Registrars are
taking and clinical supposed to attend
examination. I outpatient clinics and
was supposed to are posted as Registrars are supposed
attend daily emergency physician. to attend outpatient
Brief description of
rounds with So my job was to clinics and are posted as
duties
senior registrars admit patients and emergency physician. So
and consultants. handle all type of my job was to admit
All basic emergency except patients and handle all
procedures like IV trauma. type of emergency except
line, LP, ET Besides this we were trauma.
intubation are allowed to teach Besides this we were
taught in this junior staff and allowed to teach junior
period supervise them. staff and supervise them

Gaps in Employment
Please give details of any gaps of > 6 months in your employment or training (within last 5
years)
NO gap

Referees
Please provide the names and full contact details of at least two referees with separate
employers to cover a minimum period of three years employment and/or training history.

Please note that all reference requests will be followed up and verified by the recruiting
employer. Referees may be approached prior to interview, unless you indicate otherwise below.

Referee 1 Referee 2 Referee 3

Current or most recent
employer
 Employer  Employer  Employer
Type of Reference  Educational  Educational  Educational
 Personal  Personal  Personal
Dr Amit Mittal
Name of Referee Dr Rekha Harish
Relationship Clinical supervisor Guide and supervisor
Employer Name
Govt medical college Kurji Holy Family hospital
Employer/Hospital Patna Bihar 800012
Jammu 180001
address & post/zip code
Job title, speciality & Professor & Head, Senior Consultant
grade Department of pediatrics Pediatrics
Telephone +919419190801 +918092235180
kkrhdang@gmail.com
Email mittal.1.amit@gmail.com

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Supporting Information

If you are applying for a surgical or interventionist post and have a log book of procedures,
please provide information below about the most commonly done procedures

Number of Recorded
Procedures or Interventions
Declaration of Practical Experience
Completed
Under Senior Independently
Supervision

Teaching
Please briefly describe both formal and informal teaching you may have undertaken, the main
topics taught,& your audience (Do you hold any particular qualifications in Teaching?)

Research
Briefly describe any research projects you have undertaken over the past 5 years starting with
the most recent one. Further details can be supplied in CV
Project Title Date Aim of Research Conclusions/Actions

If you have done any audit/quality improvement project, please summarise your main learning
point in 100 words

Publications in Peer Reviewed Journals

If you wish, please list your 3 most relevant publications in peer reviewed journals.
Date and Journal Vol.59, No.3(2019). Paediatrica Indonesiana

Publication Title Cord blood bilirubin, albumin, and bilirubin/albumin ratio for predicting subsequent
neonatal hyperbilirubinemia
Authors Jehangir Allam Bhat, Sajad Ahmad Sheikh, Roshan Ara

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Date and Journal Iranian Journal of Neonatology. 2019 Sep: 10(3).

Publication Title Prevalence of Electrolyte Imbalance in Hypoxic-ischemic Encephalopathy: A

Hospital-based Prospective Observational Study
Authors Jehangir Allam Bhat, Sajad Ahmad Sheikh, Roshan Ara

Indian Journal of Otology 2018;24:42-6.

Date and Journal
Publication Title Targeted Screening for Hearing Impairment in Neonates:
A Prospective Observational Study
Authors Jehangir Allam Bhat, Rajesh Kurmi, Santosh Kumar, Roshan Ara, Amit Kumar
Mittal

Presentations: Details of 3 most relevant presentations starting with the most recent
Type
Year
Title (local/national/regional/international
presented
)

Prizes or other academic distinctions up to 3 most relevant awards/distinctions

Year
Awarding Body Description and Purpose of Award
received
Indian Academy of pediatrics Breast feeding quiz competition 2015
Indian Academy of pediatrics General pediatrics quiz competition 2017

Management and Leadership Experience

Please highlight experience you may have which is relevant to this post, not necessarily
limited to professional activities. (max. 100 words)

Team Working
Describe situations where you have been involved in working in a team, not necessarily
limited to professional activities. (max. 100 words)

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Supporting Information
Please include your reasons for applying and take the opportunity to highlight your particular
talents and strengths, (what you feel you can personally offer – what is unique to you – what
sets you apart from your peers).
Please DO NOT duplicate information already provided elsewhere in your application. (max.
300 words)

Relationships

If you are related to a director, or have a relationship with a director or employee of an

appointing organisation, please state the relationship:

Declaration

The information in this form is true and complete. I agree that any deliberate omission,
falsification or misrepresentation in the application form will be grounds for rejecting this
application or subsequent dismissal if employed by the organisation. Where applicable, I
consent that the organisation can seek clarification regarding professional registration details.

I agree to the above declaration

Signature

Name Jehangir Allam Bhat Date 30-09-2019

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