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Step 1 out of 5 BASIC DETAILS First Name: Last Name: Gender: Male Female Best Contact Number: Select One... Work Home Mobile Country Area Number   Country Number   Email: Confirm Email: Date of Birth: .... 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 .... Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec .... 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 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 Next Page   Next Step   Submit

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 Previous Page Next Page   Next Step   Submit

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.   Previous Page Submit

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 Previous Page Next Page   Next Step   Submit

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: Previous Page Next Page   Next Step   Submit

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