EOI - CAPP committee positions

EOI - CAPP committee positions

Please fill out this form to submit your EOI.
Name*

TitleFirst NameLast Name
ACEM ID*
Your Email*
In which jurisdiction are you located?*

ACTNSWNTNZQLDSATASVICWA
Select the Committee you want to apply for:*

Public Health and Disaster CommitteeQuality and Patient Safety CommitteeStandards and Endorsement Committee
Are you a:*

A. FACEM in active clinical practiceB. Trainee enrolled in and currently undertaking the FACEM Training ProgramC. ACEM member in a category other than Fellow, for example Certificant, Diplomate, Advanced Diplomate, Educational Affiliate
If C. please detail your membership category:
Are you a FACEM within the first three years of qualification?*

YesNoNot applicable
Please attach your CV*

Browse Files

Cancelof
Please confirm your understanding that the CV provided will be distributed to members of the CAPP Selection Panel for selection purposes*

Yes
Please include a brief Statement of Intent addressing the requirements of the role and knowledge, skills and experience relevant to the committee for which you are applying (not exceeding 500 words).*

Maximum 500 words0/500
The ACEM Core Values (respect, integrity, collaboration, and equity) define the organisation’s guiding principles, and underpin the way ACEM works in order to meet its vision and mission of ensuring the highest standards are maintained in the training of emergency physicians, and in the provision of emergency care to the communities of Australia and Aotearoa New Zealand. All appointees to ACEM roles and entities must now have completed the ACEM Core Values module by the close of the EOI period and demonstrate their commitment to the ACEM Core Values within their workplace.
Please confirm that you have completed the ACEM Core Values Module:*

YesNo
In less than 500 words, please describe how you demonstrate a commitment to all four ACEM Core Values within your workplace:*

Maximum 500 words0/500
ACEM Fellow/member

In submitting this EOI, I declare that I:
- am an ACEM Fellow/member in active clinical practice;
- am of Good Standing with the College and currently compliant with all renewal of Fellowship/membership requirements (including satisfactory participation in a CPD program, completion of the 2022-2023 Renewal of Fellowship Declaration);
- have no financial debts to the College (including the 2022-2023 annual subscription fee);
- have completed the ACEM Core Values module; and
- hold current medical registration with no suspension, condition(s), restriction(s) or undertaking(s) imposed by a regulatory authority that limits my ability to practise as a specialist emergency medicine physician in Australia or Aotearoa New Zealand.
FACEM trainee

In submitting this EOI, I declare that I:
- am a trainee enrolled in the FACEM Training Program;
- have no financial debts to the College;
- have completed the ACEM Core Values module; and
- hold current medical registration with no suspension, condition(s), restriction(s) or undertaking(s) imposed by a regulatory authority that limits my ability to undertake the requirements of the FACEM Training Program.
Please check this box to declare that you meet the eligibility requirements, as applicable.

Yes, I confirm I meet the eligibility requirements
Acknowledgement

I understand that the information that I provide on this EOI form and the accompanying Curriculum Vitae will be provided to members of the CAPP Selection Panel.
Should be Empty:

EOI - CAPP committee positions

ACEM Fellow/member

FACEM trainee