These placements are only for students 16 and above and those who have a genuine interest in the field of Midwifery or Obstetrics.

Please note that completion of this form does not guarantee or confirm your placement as your application will need to be reviewed to ensure safety and suitability of the placement.

Once we have your form if approved you will be sent an additional form to complete. Please note that if you do not hear back within 14 days this will have meant that your application has been rejected. Due to the volume of applications we may be unable to give feedback.

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* 1. Name

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* 2. Email

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* 3. Date of Birth

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* 4. What are your expectations of a placement within Birmingham Women's Hospital?

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* 5. How will a placement aid your future career plans?

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* 6. What experience have you had working in a hospital environment previously?

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* 7. Are you able to provide your immunization history?

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* 8. Have you applied to University?

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* 9. When would you like your placement to take place? Please leave blank if unknown (Work experience placements offered are ONE DAY placements subject to availability)

Data protection

As part of the registration process, we will collect the data submitted via this form, which we will process and hold in accordance with the General Data Protection Regulation (GDPR), in force from 25 May 2018. By submitting this form you to indicate your consent for this data to be held and processed by us for the purpose of managing your placement request only. If you do not wish to consent please exit this form.

We will not process your data for any other reason and will not share it with any third parties. We will hold your data on survey monkey until a maximum of one month after submission when it will be destroyed.

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