NRGPC - Express Interest in Locum work New Zealand

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Express Your in Interest in the Northern Rural General Practice Experience

Please complete the form below. Your expression of interest will be logged and a response forthcoming. If you prefer, print the form and fax to Fax +64 9 407 3571.

To contact us urgently please email adrienne@ruralgps.co.nz or phone:
Office +64 9 407 3561 · Mobile +64 027 292 4149 or A/H +64 9 405 9446.

(Your information will remain private. * Fields with an asterisk must be completed)

	Personal Details
	Title:
	*Name:
	*Postal Address:
	*City/Town
	State
	Post Code
	*Country
	*Tel No:
	Fax
	*Email
	*Date of Birth:
	.
*	Do you intend to bring family with you to NZ?
	.
Type of placement you are interested in
*	Locum or Permanent
*	Full-time or Part time?
.
*	Which positions are you interested in?
		Job Title/s and Ref. (if any)
.
*	What dates do you expect to be available?		Start:
			End:
.
Would you be prepared to travel within New Zealand?
.
Do you have any preferences of where you would like to work in New Zealand?
.
Qualifications and Experience
*	University & Year of Graduation .
	NZ Medical Council No. (if applicable) .or
	Medical Registration No. .
* .	Basic Qualification:
.	Other qualifications (eg. vocational registration)
*	Work Experience (including any rural general practice experience, emergency medicine experience) .

How the process works
Once you have registered your interest using the form above, we will review your information and make contact with you to discuss you application.
.
Prior to proceeding with your New Zealand registration we require:

This completed form
A current CV - listing your General Practice Experience
A current letter of good standing from your medical council
3 referees that we can contact by phone
A copy of your current Passport
Copy of current Drivers Licence
A certified copy of your Primary/Postgraduate Degree/s - plus an official translation if not in English
Verification of your Medical Registration
A copy of your current Practising Certificate
A copy of your current Medical Defence/Protection Insurance

You can provide us with these documents by fax, post or as an attachment on the page that appears after you submit this form.

In forwarding this form you authorise the Northern Rural General Practice Consortium to share your information with relevant practices, GPs and professional colleagues in relation to placement.

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