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1. Please indicate the discipline you are qualified in.
If other, please specify which discipline
1(a). Please indicate the level of employment you are seeking.
1(b). If there are no suitable vacancies in the preferred level of employment you are seeking, would you like to be considered for vacancies at an alternative level?
2. What is your specialty within your discipline (eg. Mental Health, Child Health)?
3. Do you seek permanent or temporary employment opportunities?
3(a). If Temporary:
3(b). If Permanent:
4. What is your preferred location of employment in Queensland? *
4(a). If this location is not available would you consider other locations and where?
4(b). Would you like to work in one location, or would you like opportunities to move around?
PERSONAL DETAILS: *
5. Family name:
6. Given names:
Title:
(eg. Dr/Prof/Mr/Mrs/Ms)
7. Date of birth: (dd/mm/yyyy)
(used to eliminate duplicates, to confirm Visa entitlements and for validation purposes only)
8. Contact telephone numbers: (please include international code and area code)
9. Email: (please note email is our primary method of contacting you) *
10. Postal Address:
ENGLISH LANGUAGE PROFICIENCY
A high level of English language proficiency is essential to enable practitioners to communicate with patients and health professionals and for maintenance of professional standards. Individuals must submit evidence of competency in speaking and communicating in English, to an acceptable standard, in order to obtain registration or membership with a registration board or association.
LANGUAGE SKILLS:
11. Please indicate the language competency test that you have completed: *
11(b). If you have completed the IELTS or OET examinations, please indicate scores in all four components:
Listening:
Reading:
RESIDENCY STATUS
12. What is your residency / visa status?
13. What is the name of your visa class and sub-class, plus expiry date as shown on your passport (if applicable)?
QUALIFICATIONS
14. Please provide details of your primary allied health professional qualifications:*
15. Please provide details of any associated post-graduate qualifications you have completed:
REGISTRATION STATUS
16. Please indicate your registration status: *
17. Have you commenced registration processes with the appropriate Queensland/Australian Registration Board or Membership with the appropriate Association?
CURRENT AND PREVIOUS POSITIONS (important details only):
18. Please list details of your current and your most recent positions: *
CURRICULUM VITAE
19. To process your Expression of Interest, we require you to attach your Curriculum Vitae which must include the names and contact details of three 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
21. Have you been subject to disciplinary action by a Registration Board or Association at any time? *
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.
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:
22. How did you become aware of career opportunities with Queensland Health: * (select up to 3 options total)
ADVERTISING - PRINT
ADVERTISING - WEB
EXPOS / CONFERENCES
OTHER
23. Any other comments relevant to your Expression of Interest?
Work For Us Contact Details:
* = Required fields
Last updated: 1 April 2008 Last Reviewed: 1 April 2008