Expression of Interest - Working in Canberra

Register your interest

If you are interested in working as a GP in Canberra, please fill out the form below. Before completing this form, please note the Terms and Conditions for submitting an Expression of Interest.

Personal Details

Title *

First Name *

Surname *

Date of Birth *
(dd/mm/yyyy)

(used to eliminate duplicates, to confirm Visa entitlements and for validation purposes only)

Contact Telephone Numbers
(please include international code and area code)

Preferred Contact Number *

Work

Home

Mobile

Fax

Email *

(please note, email is our primary method of contacting you)

Postal Address

Street *

(or Post Office box number)

Suburb/City *

State *

Post Code *

Country *

English Language Proficiency

A high level of English language proficiency is essential to communicate successfully with patients and colleagues. Individuals must submit evidence of competency in speaking and communicating in English, to an acceptable standard, in order to obtain registration with the ACT Medical Board. An overall B grading for the Occupational English Test (OET) or a Band 7 in the International English Language Testing System (IELTS) system is required.

If you have completed the English language competency (IELTS or OET) examinations, please indicate scores in all four components and month/year completed:

Listening

Writing

Reading

Speaking

Residency Status

What is your residency / visa status? *

Citizen of Australia
Permanent Resident of Australia
Temporary Resident of Australia
Citizen of New Zealand
Other
If other, please specify below

What is the name of your visa class and sub-class, plus expiry date as shown on your passport (if applicable)?

Medical Qualification

Qualification 1

Qualification
(eg. MBBS etc)

Name of University / College

Country of Qualification

Year Completed

Qualification 2

Qualification
(eg. MBBS etc)

Name of University / College

Country of Qualification

Year Completed

Have you commenced recognition of your overseas specialist qualifications with the AMC / relevant Specialist Medical College? *

Yes
No
N/A (Process Australian Qualification already)

Registration Status

Type of Registration *

State / Country of registration *

Registration Number *

Verification of Qualifications and Work Experience *

I verify that the information contained within this Expression of Interest form and attached Curriculum Vitae is true and correct at the date of submission. I acknowledge that should I be invited for an interview that I will be required to provide original copies.

Consent *

I agree that the ACT Medicare Local may, for the purposes of verifying my qualifications, use and disclose my personal details contained in this form, including disclosure to professional and regulatory bodies.

I agree to having my personal details released to an interested GP Practice in Canberra, ACT, for direct contact by said interested party for the purposes of employment as a GP.

Advertising Your Details *

I agree to having the following details and contact information displayed on the ACT website.

Please type the details you wish to have displayed on the Medicare Local website - describe your experience, qualifications, what you are looking for and a contact email address and/or phone number. For example: Female British-trained GP with 8 years experience seeking employment in Canberra. MRCGP and PMETB qualifications held. Special interest in paediatric health. Please contact (your name) at your email@address.com for further information.

Terms and Conditions For Submitting an Expression of Interest

These terms and conditions govern your submission of the Expression of Interest Form (the "Form"). By using or submitting this form you agree to be bound by these terms and conditions.

You must complete all sections mandatory of the Form. Personal information you provide in this form will be used by the ACT Medicare Local for employment related purposes and / or to determine your possible suitability for employment as a GP in Canberra, ACT, Australia. ACT Medicare Local reserves the right to use and disclose the information provided by you in the Form to verify your qualifications and / or standing, including disclosing your information to professional and/or regulatory bodies. We also reserve the right to advertise your details and availability (in words chosen by you) on our website, www.actml.com.au

While ACT Medicare Local endeavours to ensure that the online transmission of the Form, containing your information, over the internet is secure, the inherent nature of the internet means that there is a potential risk that your information may be viewed or intercepted by third parties. Accordingly, submission through the online Form shall be at your own risk and ACT Medicare Local accepts no responsibility or liability for any unauthorised access to your information contained in the Form when it is submitted online over the internet.

ACT Medicare Local makes no representation at the time the Form is submitted or any time in the future, that there is a suitable position or any position, available to you, or that you will be considered for a position that becomes available. In addition, ACT Medicare Local makes no representation that by submitting your Form you will be notified of any or all appropriate vacancies; offered an interview in relation to a vacant position; or be offered a position as a General Practitioner in Canberra, ACT.

You warrant that the information you submit on this Form is accurate and complete at the time of submission. You also warrant that you have not submitted the Form on behalf of any other person.

I hereby accept and agree to abide by the above terms and conditions for submitting this Form. *

Declaration *

I declare the information on this form to be correct at the time of submission.

How did you hear about us? *

Australian Doctor
Medical Observer
Seek.com.au
Careerone.com.au
Live in Canberra
Google
Other
If other, please tell us where

Word Verification *

(letters are not case-sensitive)

Enter the text in the image above