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Role Player Application Form
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1.
Title
(Required.)
Mr
Mrs
Miss
Ms
None of the above
Other (please specify)
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2.
Full Name
(Required.)
*
3.
What is your gender?
(Required.)
Female
Male
Other (specify)
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4.
Playing Age
(Required.)
Under 18
18-20
21-30
31-40
41-50
51-60
60-65
65+
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5.
Build
(Required.)
Slim
Medium
Large
Muscular
Extra Large
Other (please specify)
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6.
Physical Examination Consent
(Required.)
Yes
No
Other (please specify)
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7.
Location(s)
(Required.)
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
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8.
Role Play Experience
(Required.)
Medical
Corporate
Real Patient
None
Other (please specify)
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9.
Ethnicity
(Required.)
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)
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10.
Do you speak any other language than English fluently?
(Required.)
Yes
No
If yes please give further details
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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?
(Required.)
Yes
No
Would rather not say
If yes, how would you define this impairment.
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12.
Contact details
(Required.)
Name
Address
City/Town
ZIP/Postal Code
Country
Email Address
Phone Number
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13.
Vetting
(Required.)
DBS
NPPV
Other (please specify)
None of the above
*
14.
Cover letter
(Required.)
15.
Headshot
Please attached headshot
Choose File
No file chosen
*
16.
CV
(Required.)
Please attach CV
Choose File
No file chosen
*
17.
I consent for MRP Ltd to contact me about my application
(Required.)
Agree
Disagree
