Application to be an RDN Locum

Please note that fields marked with an asterisk (*) are required in order to successfully register your application.

General Practitioner applying to be an RDN Locum

*Surname

*First Name

*Preferred Name

*Other Names

*Postal Address Line 1

Postal Address Line 2

*Town/Suburb

*State

*Country

*Postcode

*Tel (Business Hours)

*Tel (After Hours)

Fax

*Email

Mobile Number

*Best method of contact at short notice

*Do you want to work as an RDN Locum:

Full Time
(Continuous work for a minimum of six (6) months or longer in short term locums across NSW)

Casual
(At least one two week rural NSW locum, with a flexible term of employment reviewed annually)

Are there any regions or towns in NSW that you would NOT WORK as a locum?

Do you have any OTHER SPECIALITY QUALIFICATIONS appropriate to employment as an RDN locum?

Accident & Emergency

Surgery

Obstetrics

Anaesthetics

Aditional specialities / interests?

* Reduced, Suspended or Revoked Clinical Privileges

Have your clinical privileges and / or appointment at any hospital or day procedure centre ever been reduced, suspended or revoked or have you had conditions attached to that appointment for any reason? If so, please specify:

* Medical Registration Conditions

Are there any conditions attached to your medical registration? If so, please provide details:

* Professional Indemnity Insurance Issues

Has your professional indemnity insurer / fund ever applied conditions or refused to renew your cover or membership? If so, please provide details:

*Please attach your current resume

(include three (3) recent work referees - name, address, and fax/email/tel):

I, the abovementioned, by clicking the 'Submit my Application' button, certify that the information contained herein is full and accurate.

Thank You. For further information or assistance, please contact the RDN Locums Service on phone +61 2 4924 8060 or email locums@nswrdn.com.au