Link to Queensland Government (www.qld.gov.au)

Oral Health

Health Services > Oral Health

Expression of Interest for Graduate Positions

For Dentists, Oral Health Therapists, Dental Technicians and Dental Prosthetists

NOTE: Please ensure that you do not move forward or back in this browser window once you have begun completing this form as you may encounter loss of data.

1. Please indicate the field of employment you are seeking:

	Oral Health Therapist		Dental Technician
	Dentist		Dental Prosthetist

2. Do you seek permanent or temporary employment opportunities?

	Permanent (go to 3(b).)
	Temporary (go to 3(a).)

2(a). If Temporary:

Number of months:
Start date:
End date:

2(b). If Permanent:

Start date:

3. What is your preferred location of employment in Queensland?*
View Queensland Health - Health Service Districts map

Option 1:

Required

Option 2:

Option 3:

Option 4:

Option 5:

3(a). Please list any other locations that you would consider working in:

3(b). Would you like to work in one location, or would you like opportunities to move around?

	One location
	Move around
	Either

PERSONAL DETAILS: *

4. Family name:

Required

5. Given names:

Required

6. Title:

(eg. Dr/Prof/Mr/Mrs/Ms)

7. Date of birth: (dd/mm/yyyy)

(used to eliminate duplicates and for validation purposes only)

8. Contact telephone numbers: (please include international code and area code)

Preferred contact number:	*
Work:		Home:
Mobile:		Fax:

9. Email: (please note email is our primary method of contacting you) *

10. Postal Address:

Street number and name: (or Post Office box number)
Suburb / Town:
State / Province:
Post Code / Zip Code:
Country:

RESIDENCY STATUS

11. 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

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

Name: Expiry Date:

ORAL HEALTH QUALIFICATIONS

13. Please provide details of your primary dental qualifications:

Qualification (eg. BDS etc)	Name of university / college	Country of qualification	Year completed




** Please note for primary dentalqualifications other than Australian, UK , Ireland or NZ please refer to Australian Dental Council for registration purposes http://www.dentalcouncil.net.au/

REGISTRATION STATUS

14. Please indicate your registration status:

Registration to be completed.

	Type of registration	Country of registration	Registration Number
Current
Previous
Previous

CURRICULUM VITAE

15. To process your Expression of Interest, we require you to attach your Curriculum Vitae which must include the names and contact details of two referees, one preferably being your immediate and current supervisor:

Please note that only the following file types will be accepted: .doc, .rtf, .pdf and .txt.
Please also note that large documents will take some time to process.

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 with a Health Service District (and appointed, if successful) that I will be required to provide an original Curriculum Vitae that is signed and includes the following statement on the first page "This Curriculum Vitae is true and correct as at <insert date>"

CONSENT:

“I agree that Queensland Health 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.”

DISCLOSURE

16. Have you been subject to disciplinary action by a Dental Registration Board at any time ? *

	Yes
	No
If Yes, please provide specific details of disciplinary action

TERMS AND CONDITIONS FOR SUBMITTING AN EXPRESSION OF INTEREST

These terms and conditions govern your submission of the Expression of Interest Form (the “Form”) and your access to and use of the Form and related web pages. By using or submitting this form you agree to be bound by these terms and conditions.

You must complete all sections of the Form. If you do not complete the Form we will be unable to assess your suitability for a position with Queensland Health and will be unable to notify you of any vacancies. The information provided by you will be valid for a period of up to 12 months and will only be retained by Queensland Health for a period of up to 12 months. After this period has expired we will dispose of the information and you will need to submit a new Form. If you wish to update any information you have submitted in the Form you will also need to submit a new Form.
Personal information you provide in this form will be used by Queensland Health for employment related purposes and / or to determine your suitability for employment within the public health system in Queensland. In addition, we may use your information for statistical purposes; however any information will be de-identified for this purpose. Queensland Health 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 will not disclose your information for any other purpose unless we obtain your consent, or we are required or permitted to do so by law or in accordance with the requirements of Information Standard 42A – Information Privacy for the Queensland Department of Health (“IS42A”). Your information, contained in this Form, will be potentially open for release under the Freedom of Information Act 1992, Queensland. You can access this legislation through the following link: http://www.legislation.qld.gov.au/LEGISLTN/CURRENT/F/FreedomInfoA92.pdf
While Queensland Health 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 Queensland Health accepts no responsibility or liability for any unauthorised access to your information contained in the Form when it is submitted online over the internet. Individuals who submit the Form online should receive an acknowledgement from Queensland Health that the Form has been sent, on the screen, following submission. Queensland Health accepts no responsibility or liability if this acknowledgement does not appear or we do not receive your online submission.
Queensland Health 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 Queensland Health. In addition, Queensland Health 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 with Queensland Health.
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.

You acknowledge that you have read and understood Queensland Health’s Privacy Statement and Disclaimer.

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. *

FEEDBACK:

17. How did you become aware of career opportunities with Queensland Health: *

Queensland Health website	Promotional Material (eg Flyers, merchandise etc)
Seek.com.au	Qld Health Information Session
VirtualCareersExpo.com.au	Visit to Queensland or Australia
WorkingIn.com	Word of Mouth (Family / Friend / Colleague)
Other website	Other Professional Conference / Expo

18(a) What attracted you to work for Queensland Health?

18(b) What do you expect to achieve by working for Queensland Health?

19. Any other comments relevant to your Expression of Interest?

Contact for Graduate Program:

Ph: +61 7 3131 6959
Fax: +61 7 3131 6817
Email: Oral_Health@health.qld.gov.au

* = Required fields

Last Updated: 17 July 2008
Last Reviewed: 17 July 2008