Salubris is committed to providing doctors, nurses and allied health professionals to our clients in Australia and overseas. If you are interested in working in Australia or overseas, please fill out the form below and attach your CV in word format so that one of our consultants can review your experience, education and skills. Once reviewed one of our consultants will get back to you to advise you on your suitability to apply for one of our positions and the further steps you need to take.
I am applying for a position as a:
Medical Practitioner
Registered Nurse
Enrolled Nurse
Midwife
Allied Health Professional
Your Details
*First Name:
*Last Name:
*Gender
Male
Female
*Date of Birth:
dd/mm/yy
Country of Birth:
*Passport No.
*Postal Address:
*Postcode:
*State:
*Country
Contact Details
Phone Number(home):
please include country/area codes
Phone Number(business):
Phone Number(Mobile):
Fax Number:
Email:
*Australian residency Status (if applicable):
Choose
Australian Citizen
Australian Permanent Resident
New Zealand Citizen
Temporary Australian Resident
No Australian Visa
How did you hear about Salubris
Web page
Advertisement
Word of Mouth
Other
Other (please specif):
Various Questions
When and where are you thinking of travelling?
What day and time (AEST) are you available to be interviewed?
Time between:
am
pm
and
am
pm
Day:
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
How much notice do you need to give your current employer
In what countries have you worked before using your skills as a medical practitioner, nurse or allied health professional?
If you where offered a position in Australia or elsewhere, what would be your planned length of stay?
Do you have a preferred location of where you would like to work? If you do have a preferred country please indicate a city or state.
Education
Primary Degree
*University:
*Country:
*Course Name:
*Year Completed
Dates of Internship
Post Graduate Qualifications
Qualification
Country
Year Completed
1.
2.
3.
4.
5.
6.
Other Exams
Qualification/Exam
Country
Year Completed
1.
2.
3.
4.
5.
6.
Memberships
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Continuing Medical Education
Qualification
Year Completed
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Publications
1.
2.
3.
4.
5.
6.
Research
1.
2.
3.
4.
5.
6.
Skills:
Your areas of experience and speciality:
Clinical Experience
Start Date
(mm/yy)
End Date
(mm/yy)
Institution/practice
Position
Country
Type of medicine/hosipital department
Responsibilities
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Referees
Please provide details of at least three referees with whom you have worked or reported in the last three years. One must be from a current employer.
Referee 1
Name:
Contact Address:
Position:
Contact Telephone Number:
Relationship to Referee:
Fax Number:
Duration worked with:
Email:
Referee 2
Name:
Contact Address:
Position:
Contact Telephone Number:
Relationship to Referee:
Fax Number:
Duration worked with:
Email:
Referee 3
Name:
Contact Address:
Position:
Contact Telephone Number:
Relationship to Referee:
Fax Number:
Duration worked with:
Email:
Family
Next of Kin Name:
Next of Kin Address:
Next of Kin Telephone Number:
Do you have any children?
yes
no
If yes, please indicate their ages (seperate with a comma):
Are you married?
yes
no
Any additional comments you would like to add?
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