Medical Practitioner Registration Form

Medical Practitioner Registration Form

Application details

Contact details

Are you an Australian citizen / Permanent resident? *
Do you have a working visa? *

Clinical referee details

(Please note: Two referees are required. At least one referee should have been working with you in your past or existing role)

Referee 1

Referee 2

Financial details

Banking details

Medicare information

Are you affected by 19AB?
Are you affected by 19AA?

Emergency contact

Certification

I hereby certify that the above information is correct and complete to the best of my knowledge and belief. I understand that, if I am contracted, I will be liable to dismissal if any of the statements in my application are found to be deliberately misleading.

Do you agree with the above?*

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Ozhealth's Privacy Policy

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Ozhealth Privacy Policy

Ozhealth's Candidate's Terms of Engagement

Please read the Terms of Engagement in the link below:*

Candidate's Terms of Engagement

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