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BASIC DETAILS
First Name:
Last Name:
Gender:
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Best Contact Number:
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Work
Home
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Number
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Email:
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Date of Birth:
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1974
1975
1976
1977
1978
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1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
Country Graduated Medical School:
Select Country...
Afghanistan
Albania
Algeria
Angola
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bolivia
Bosnia-Herzegowina
Botswana
Brazil
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China
Colombia
Congo
Cook Islands
Costa Rica
Croatia
Cuba
Czech Republic
Czechoslovakia
Democratic Republic of the Congo
Denmark
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Estonia
Ethiopia
Fiji
Finland
France
Gabon
Georgia
Germany
Ghana
Greece
Grenada
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Liberia
Libya
Lithuania
Macedonia
Madagascar
Malawi
Malaysia
Mali
Malta
Mauritius
Mexico
Micronesia
Moldova
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nepal
Netherlands
Netherlands Antilles
New Zealand
Nicaragua
Niger
Nigeria
Niue
North Korea
Norway
Oman
Pakistan
Palestinian authority
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Qatar
Romania
Russia
Rwanda
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Vincent and the Grenadines
Samoa
Saudi Arabia
Senegal
Sierra Leone
Singapore
Slovak Republic
Slovenia
Solomon Islands
Somalia
South Africa
South Korea
South Yemen
Spain
Sri Lanka
Sudan
Suriname
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
USA
Uzbekistan
Vanuatu
Venezuela
Viet Nam
Yemen
Zambia
Zimbabwe
Year Graduated Medical School:
Select Year...
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
Current Location:
Select Country...
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Azores
Bahamas
Bahrain
Balearic Islands
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire
Bosnia-Herzegowina
Botswana
Brazil
British Antarctic Territory
British East Africa
British Indian Ocean Territory
British Virgin Islands
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Canary Islands
Cape Verde
Cayman Islands
Central African Republic
Chad
Channel Islands
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo
Cook Islands
Corsica
Costa Rica
Croatia
Cuba
Curacao
Cyprus
Cyprus (Greek)
Cyprus (Turkish)
Czech Republic
Czechoslovakia
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Dutch East Indies
East Timor
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Faeroe Islands
Falkland Islands
Fiji
Finland
France
French Guiana
French Polynesia
Gabon
Gambia
Gaza Strip
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Ivory Coast
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Korea
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Madeira Islands
Malawi
Malaysia
Maldives
Mali
Malta
Mariana Islands
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Media
Mexico
Micronesia
Midway Islands
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Korea
North Vietnam
North Yemen
Norway
Oman
Pacific Islands Trust Territory
Pakistan
Palau
Palestinian authority
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Island
Poland
Portugal
Qatar
Reunion
Romania
Ross dependency
Russia
Rwanda
Ryukyu Islands
Saba
Saint Eustatius
Saint Helena and Dependencies
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Sikkim
Singapore
Slovak Republic
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia
South Korea
South Sandwich Islands
South Vietnam
South Yemen
Spain
Sri Lanka
Sudan
Suriname
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
USA
USSR
Uzbekistan
Vanuatu
Vatican City
Venezuela
Viet Nam
Wake Island
Wallis and Futuna
West Bank
West Germany
Western Sahara
Yemen
Yugoslavia
Zambia
Zimbabwe
Nationality:
Select Country...
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Azores
Bahamas
Bahrain
Balearic Islands
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire
Bosnia-Herzegowina
Botswana
Brazil
British Antarctic Territory
British East Africa
British Indian Ocean Territory
British Virgin Islands
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Canary Islands
Cape Verde
Cayman Islands
Central African Republic
Chad
Channel Islands
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo
Cook Islands
Corsica
Costa Rica
Croatia
Cuba
Curacao
Cyprus
Cyprus (Greek)
Cyprus (Turkish)
Czech Republic
Czechoslovakia
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Dutch East Indies
East Timor
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Faeroe Islands
Falkland Islands
Fiji
Finland
France
French Guiana
French Polynesia
Gabon
Gambia
Gaza Strip
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Ivory Coast
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Korea
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Madeira Islands
Malawi
Malaysia
Maldives
Mali
Malta
Mariana Islands
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Media
Mexico
Micronesia
Midway Islands
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Korea
North Vietnam
North Yemen
Norway
Oman
Pacific Islands Trust Territory
Pakistan
Palau
Palestinian authority
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Island
Poland
Portugal
Qatar
Reunion
Romania
Ross dependency
Russia
Rwanda
Ryukyu Islands
Saba
Saint Eustatius
Saint Helena and Dependencies
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Sikkim
Singapore
Slovak Republic
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia
South Korea
South Sandwich Islands
South Vietnam
South Yemen
Spain
Sri Lanka
Sudan
Suriname
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
USA
USSR
Uzbekistan
Vanuatu
Vatican City
Venezuela
Viet Nam
Wake Island
Wallis and Futuna
West Bank
West Germany
Western Sahara
Yemen
Yugoslavia
Zambia
Zimbabwe
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Step 2 out of 5
INTERNATIONAL AND OTHER MEDICAL EXAMS
AUSTRALIAN MEDICAL EXPERIENCE?
Yes
No
I am no longer registered
I was registered in State:
Select One...
ACT
NSW
NT
QLD
SA
TAS
VIC
WA
For the duration of:
Years
Months
I am currently registered
State:
Select One...
ACT
NSW
NT
QLD
SA
TAS
VIC
WA
Reg Type:
Select One...
Full
Conditional
I have been registered for:
Years
Months
I have passed exams in
Australia (AMC, RACGP)
AMC Exams
AMC-MCQ
AMC-CLINICAL
AMC-WORKPLACE-BASED-ASSESMENT
FRACGP
Assessed by RACGP
Years
Months
AKT
KFP
FRACGP Clinical
Awarded Fellowship
Canada (MCC)
MCC Evaluating Exam
MCC Qualifying Exam Part 1
MCC Qualifying Exam Part 2
New Zealand (NZREX)
NZREX
Completed Internship in New Zealand
United Kingdom (GMC, PLAB)
PLAB 1
PLAB 2
12 months supervised training or foundation year 1
Full GMC Registration
United States (ECFMG, USMLE)
USMLE 1
USMLE 2CK
USMLE 2CS
USMLE 3
2 or more years residency training
I have NOT passed any of the above exams
Other exams I have passed
Please tell us about other exams you have passed...
500 characters left
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Step 5 out of 5
MANDATORY MEDICAL EXAMS REQUIREMENTS
AMC MCQ or RACGP AKT must be passed to work in Australia
I do not intend to take any exam and am aware that
I can't work in Australia
I am thinking of taking an exam
Exam:
Select One...
AMC-MCQ
RACGP-AKT
In the next:
Select One...
6 Months
6 - 12 Months
More than 12 Months
I have a confirmed exam date
Confirmed Exam:
Select One...
AMC-MCQ
RACGP-AKT
Confirmed Date:
......
Early
Mid
Late
......
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
......
2010
2011
MANDATORY ENGLISH EXAMS REQUIREMENTS
IELTS-Academic or OET must be passed to work in Australia
I do not intend to take any exam and am aware that
I can't work in Australia
I am thinking of taking an exam
Exam:
Select One...
IELTS - Academic
OET
In the next:
Select One...
6 Months
6 - 12 Months
More than 12 Months
I have a confirmed exam date
Confirmed Exam:
Select One...
IELTS - Academic
OET
Confirmed Date:
......
Early
Mid
Late
......
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
......
2010
2011
Thanks for taking the time to fill in your information.
Click on "Submit" to finish.
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Step 3 out of 5
ENGLISH EXAMS
English Exam Exception
I have completed all my Secondary Education from an Exempt Country (South Africa, UK, USA, Ireland, Australia, New Zealand, Canada)
I have finished my Secondary Education in:
Select One...
South Africa
United Kingdom
United States
Ireland (Republic)
Australia
New Zealand
Canada
English Exams Taken
IELTS-ACADEMIC
Some components less than 7 (not the overall score)
All components 7 or more (not the overall score)
Date you sat IELTS:
Select One...
January
February
March
April
May
June
July
August
September
October
November
December
Select One...
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
Your Exam has expired.
Have you been actively employed
as a Full Time Medical Doctor,
since the expiry of this exam
in the above exempt countries.
Select One...
Yes
No
(observership / clinical attachement not accepted)
OET
Less than B in any section or more than one sitting
Minimum of B in all sections in one sitting only
Date you sat OET:
Select One...
January
February
March
April
May
June
July
August
September
October
November
December
Select One...
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
Your Exam has expired.
Have you been actively employed
as a Full Time Medical Doctor,
since the expiry of this exam
in the above exempt countries.
Select One...
Yes
No
(observership / clinical attachement not accepted)
PLAB 2
Date you passed PLAB 2:
Select One...
January
February
March
April
May
June
July
August
September
October
November
December
Select One...
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
Your Exam has expired.
Have you been actively employed
as a Full Time Medical Doctor,
since the expiry of this exam
in the above exempt countries.
Select One...
Yes
No
(observership / clinical attachement not accepted)
NZREX
Date you passed NZREX:
Select One...
January
February
March
April
May
June
July
August
September
October
November
December
Select One...
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
Your Exam has expired.
Have you been actively employed
as a Full Time Medical Doctor,
since the expiry of this exam
in the above exempt countries.
Select One...
Yes
No
(observership / clinical attachement not accepted)
No English Exams Taken
I have not taken the above English exams yet
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Step 4 out of 5
SPECIALTY AND CAREER INFORMATION
Total Years Experience Working as a Doctor:
What is your Level?
Select One...
Intern/ House Officer
Resident / RMO / JHO / SHO / PHO
Registrar / Resident in Training (USA)
Specialist / Consultant / Fellow
Family / General Practitioner
Do you have a Specialty?
Yes
No
Specialty:
Select One...
Family / General Practice
Accident & Emergency
Anesthetics
Dermatology
Intensive Care
Internal Medicine
Medical Admin
Obstetrics and Gynaecology
Occupational Medicine
Ophthalmology
Paediatrics
Pallative Medicine
Pathology
Psychiatry
Public Health
Radiology
Rehabiliation Medicine
Surgery
Have you ever worked as a Family Doctor / General Practitioner?
Yes
No
Years Experience:
Position you are seeking
Select One...
GP
- General Practitioner / Family Physician Post
HOSPITAL - Intern / Resident / Registrar / Specialist post ONLY (not GP)
BOTH (GP / HOSPITAL) - I am able to work in both positions
Desired length of contract
Select One...
Less than one year
1-2 years
3-4 years
4 years or more
Career Plans & Other Comments
Attach CV:
** Mandatory **
Attach Photo:
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