UK-Med – We believe in a world prepared to help.



OUTBREAK RESPONSE ROSTER (ORR) APPLICATION QUESTIONS (please complete and return to recruitment@uk-)First Name(s):Surname:OUTBREAK RESPONSE ROSTER (please tick the role(s) that you are looking to apply for)Clinical Team Lead Midwife EpidemiologistPublic Health Expert Medical Doctor IPC CoordinatorClinical TrainerNurse (Paediatric) WASH AdvisorCoordinationCurrent employment (or most recent):Position held:Type of contract:Self EmployedEmployed ConsultantDo you have any humanitarian experience?YESIf YES, please state the approximate length of time and type(s):< 6 mnths.6 mnths. – 1 yr. 1 – 2 yrs. NO2 – 5 yrs.5 – 10 yrs.10 + yrs.Emergency DevelopmentHeadquarters Do you have outbreak response experience?YESIf YES, please state the approximate length of time:< 6 mnths.6 mnths. – 1 yr.1 – 2 yrs.NO2 – 5 yrs.5 – 10 yrs.10 + yrs.What type of outbreak response activities have you undertaken in the past?EbolaCholeraDengueLassa FeverYellow FeverMeaslesOtherState:Have you worked in a conflict setting before?YESIf YES, please state the context: (Country/countries)NOWould you be willing to work in a high-risk context i.e. conflict, Ebola virus etc.(this is not used as a exclusion criterion for selection)YESIf YES, please state what you would be comfortable with:Conflict settingEbola Virus Disease Ebola in a conflict settingNOInsecure environmentDisaster prone areasAustere environment Language SkillsEnglishFrenchSpanishArabicOther: ________SpeakingBasicBasicBasicBasicBasicIntermediateIntermediateIntermediateIntermediateIntermediateGoodGoodGoodGoodGoodVery GoodVery GoodVery GoodVery GoodVery GoodFluent/Mother Tongue Fluent/Mother Tongue Fluent/Mother Tongue Fluent/Mother Tongue Fluent/Mother Tongue ListeningBasicBasicBasicBasicBasicIntermediateIntermediateIntermediateIntermediateIntermediateGoodGoodGoodGoodGoodVery GoodVery GoodVery GoodVery GoodVery GoodFluent/Mother Tongue Fluent/Mother Tongue Fluent/Mother Tongue Fluent/Mother Tongue Fluent/Mother Tongue WritingBasicBasicBasicBasicBasicIntermediateIntermediateIntermediateIntermediateIntermediateGoodGoodGoodGoodGoodVery GoodVery GoodVery GoodVery GoodVery GoodFluent/Mother Tongue Fluent/Mother Tongue Fluent/Mother Tongue Fluent/Mother Tongue Fluent/Mother Tongue What is the maximum length of deployment that you can undertake to the field, at any one time?< 6 weeks6 weeks max6 – 12 weeks12 + weeksWhat is your nationality? (please state all that you hold current passports for)What is your official country of domicile?For immediate deployments, where would you need to travel from?Do you have experience of training & capacity building? YES NO If YES, please describe (in less than 100 words)In less than 100 words, please explain why you want to be considered for UK-Med’s Outbreak response roster? In less than 100 words for each, please give ‘real life’ examples based on your past experience demonstrating your understanding and experience in the following areas:Leadership and coordination in outbreak responseOutbreak preparedness and contingency planningTechnical advisory rolesPlease specify the date you are available from?Remote working:International Deployment:Have you previously undertaken any (Hostile Environment Awareness Training - HEAT)YESIf YES, please state when this was:________________NOThank you for time – we will review your application and be in touch soon.Please ensure you also submit an updated CV to recruitment@uk-Technical enquiries about the programme should be sent to sarah.collis@ ................
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