Role Player Application Form Question Title * 1. Title Mr Mrs Miss Ms None of the above Other (please specify) Question Title * 2. Full Name Question Title * 3. What is your gender? Female Male Other (specify) Question Title * 4. Playing Age Under 18 18-20 21-30 31-40 41-50 51-60 60-65 65+ Question Title * 5. Build Slim Medium Large Muscular Extra Large Other (please specify) Question Title * 6. Physical Examination Consent Yes No Other (please specify) Question Title * 7. Location(s) North West North East Yorkshire & North Lincolnshire East Midlands West Midlands South East South West Eastern England Scotland Wales Northern Ireland Other (please specify) None of the above Question Title * 8. Role Play Experience Medical Corporate Real Patient None Other (please specify) Question Title * 9. Ethnicity White Eastern European Mediterranean Native American Black or African American Asian Indian Asian East East Indian Middle Eastern Hispanic or Latino Asian or Asian American Other (please specify) Question Title * 10. Do you speak any other language than English fluently? Yes No If yes please give further details Question Title * 11. Equality Act (2010)This Act protects people with disabilities from unlawful discrimination. We actively encourage applications from people with disabilities.The Equality Act defines a disabled person as someone who has a physical or mental impairment which has a substantial and adverse long term effect on his or her ability to carry out normal day to day activities.Do you consider yourself to be disabled according to this definition? Yes No Would rather not say If yes, how would you define this impairment. Question Title * 12. Contact details Name Address City/Town ZIP/Postal Code Country Email Address Phone Number Question Title * 13. Vetting DBS NPPV Other (please specify) None of the above Question Title * 14. Cover letter Question Title * 15. Headshot Please attached headshot PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only. Choose File Choose File No file chosen Remove File Please attached headshot Question Title * 16. CV Please attach CV PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only. Choose File Choose File No file chosen Remove File Please attach CV Question Title * 17. I consent for MRP Ltd to contact me about my application Agree Disagree Please double check before submitting - SUBMIT
