Psychiatrist Job Application Form

1

Full Legal Name* This field is required.

First Name

Last Name

2

Date of Birth* This field is required.

Date

3

Phone Number* This field is required.

Mobile Number

4

Email Address* This field is required.

myname@example.com

5

Address* This field is required.

Street Address

Street Address Line 2

Suburb

State

Post Code

Country

6

ABN Number* This field is required.

7

Prescriber Number* This field is required.

8

What is your current residency status in Australia?* This field is required.

Australian Citizen

Australian Permanent Resident

New Zealand Citizen (with unrestricted work rights)

Temporary Visa with full work rights

No current work rights – require sponsorship

Other

9

What type of work arrangement are you interested in with our clinic?* This field is required.

Face-to-Face at Sydney Clinic

Face-to-Face at Melbourne Clinic

Telehealth

Other

10

What is your preferred start date with us?* This field is required.This can be confirmed during onboarding.

Date

11

How many hours per week are you planning to work with us initially?* This field is required.Please note: the minimum commitment is 2 days per week for Face-to-Face work, or 15 hours per week for Telehealth work.

2 days or 15 hours per week

3 days or 22.5 hours per week

4 days or 30 hours per week

5 days or 37.5 hours per week

12

Which day(s) of the week are you available to work with us?* This field is required.Please list your preferred days. This can be confirmed during onboarding.

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

13

Are you a current Fellow of the Royal Australian and New Zealand College of Psychiatrists (FRANZCP)?* This field is required.

YESNO

14

When did you obtain your Fellowship with RANZCP (FRANZCP)?* This field is required.

Year

15

When do you expect to obtain your Fellowship (FRANZCP)?* This field is required.

Date

16

APHRA Registration Number* This field is required.

MED000xxxxxxx

17

Are you currently subject to the 10-year Medicare Moratorium (Section 19AB)?* This field is required.We welcome applicants with moratorium restrictions.

YESNO

18

When do you expect the 10-year Medicare Moratorium to end?* This field is required.

Date

19

What is the youngest patient you would accept:* This field is required.

Year Old

20

What is the oldest patient you would accept:* This field is required.

Year Old

22

Are there any other conditions you would accept:

23

Are there any other conditions you would not accept:

24

1. Driver License* This field is required.

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Select files to upload

Max. file size: 10.0MB

25

2. Australian Passport or Foreign Passport with Australian Visa* This field is required.

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Max. file size: 10.0MB

26

3. AHPRA Certificate* This field is required.

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Select files to upload

Max. file size: 10.0MB

27

4. RANZCP Fellowship Certificate* This field is required.

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Select files to upload

Max. file size: 10.0MB

28

5. Bachelor Degree Graduation Certificate* This field is required.

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Select files to upload

Max. file size: 10.0MB

29

6. Employment evidence (for last 2 employment)* This field is required.

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Select files to upload

Max. file size: 10.0MB

30

7. Resume* This field is required.

Drag and drop files here

Select files to upload

Max. file size: 10.0MB

31

References

Please provide details of 2 References. Reference check may be conducted legally and all information will remain confidential.

I understand and agree that Mind Oasis Clinic may contact the referrer I have provided below for reference check purposes. I confirm that the References below agreed to be contacted by Mind Oasis Clinic for reference check purposes.

32

Reference 1

33

Reference 2

35

Applicant Declaration & Signature* This field is required.I declare that the information I have provided in this application is true and correct to the best of my knowledge. I understand that any false or misleading information may result in disqualification from the recruitment process or termination of employment if already hired.

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36

Date of Submission* This field is required.

Date