Consultant Psychiatrist Recruitment Form

Selection Criteria:

I have obtained the RANZCP fellowship, or less than 4 months away to obtaining fellowship. *

I have obtained the Child and Adolescent Advanced Certificate, or am in the process of completion. *

I am impacted by the section 19AB moratorium restrictions.

Personal Information

Full Name *

Date of Birth *

Address *

Street address *Street address line 2

City *

State *Please selectACTNSWNTQLDSATASVICWA

Postcode *

CountryPlease selectAfghanistanAlbaniaAlgeriaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCentral African RepublicChadChileChinaColombiComorosCongo (Brazzaville)CongoCosta RicaCote d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast Timor (Timor Timur)EcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceGabonGambia, TheGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKorea, NorthKorea, SouthKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint VincentSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbia and MontenegroSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamYemenZambiaZimbabwe

Email Address *

Phone Number *

Employment Details and Requirements

I am looking for *

Full-Time equivalent (up to 38 hours per week)Part-Time equivalent (at least 16 hours per week)

I prefer to be a: *

Salaried employee (receive wages + superannuation)Contractor (charged sessional fee + percentage of billings)Unsure - I would like to discuss further

Preferred date of commencement *

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Curriculum Vitae *

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Current AHPRA Registration Certificate *

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Evidence of COVID-19 vaccination status or exemption *

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RANZCP Fellowship Letter/Certificate, or latest training progression record *

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Child and Adolescent Advanced Training Certificate, or evidence of latest advanced training record *

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Cover Letter (optional - you may include personal background, specific areas of interest, career goals)

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Other documents

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Other information

Referee Details

Referee #1

Full Name *

Role *

Relationship to Applicant *

Contact Number *

Email Address *

How long have you known Referee #1 *

Referee #2

Full Name *

Role *

Relationship to Applicant *

Contact Number *

Email Address *

How long have you known Referee #2 *

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Privacy and Personal Information Consent

I, *

consent to the collection of necessary personal information, including age, gender, medical history / reports, address details and criminal history checks.

I hereby declare that the information I have provided in this form is true and accurate and I authorise the company to verify any information if required. Any false or misleading information may result in the termination of my position / application.

I have read and understood my rights in respect of access to and collection of my personal information.

Signature *

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Date *

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