Whether you are New Zealand based, or currently overseas, planning to travel to New Zealand, we would like to help you with your
plans. Please share a few details with us to get started and we will be pleased to contact you.
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| Title |
First names * |
Surname * |
Date of birth |
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| Postal address |
Physical address |
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| Home phone no. |
Home fax no. |
Mobile phone no. |
Email * |
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| Work phone no. |
Work fax no. |
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| Partner/Travel Companion |
Please indicate partner/travel companion's chosen career (esp. if within healthcare) |
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| Qualification country |
Qualification year |
Qualification university |
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| Postgraduate qualifications (please incl. all details) |
CCST |
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| Do you have New Zealand Medical Council registration? |
Registration no. (if yes) |
| Yes |
No |
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| Current medical indemnity insurance |
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| Are you are currently, or have ever been the subject of professional disciplinary proceedings, a competence
enquiry, or a mental or physical condition entailing either conditions or a restriction being placed on your medical
registration? |
(If yes) Please discuss with us for any additional documentation as may be required. |
| Yes |
No |
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Preferred Working details (we understand that plans might change) |
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| Preferred Workplace |
Preferred Hours |
Shifts |
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Evenings |
Weekends |
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| Any preferred geographical locations |
Leisure activities/Interests |
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| Proposed travel dates |
Length of stay |
Existing future commitments/Proposed plans, if any |
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| Are you willing to travel within New Zealand? |
Are you a car owner? |
| Yes |
No |
Yes |
No |
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| Please list any other recruitment agencies approached regarding work in New Zealand |
Please list any medical authorities you have directly approached |
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Curriculum Vitae |
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| We welcome you to attach your CV. If your CV is ready, please select the option below that best suits
your CV format, thank you. |
| Word Format |
PDF Format |
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Please email your PDF CV to info@locums.co.nz with a brief message
that includes your name. |
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| How did you hear about Gold Standard Locums? |
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I acknowledge I have read
and accept this declaration
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All the above information, as supplied by me, is to the best of my knowledge correct, accurate and complete.
I understand that I am authorising Gold Standard Locums (GSL) to release my Curriculum Vitae and if necessary, obtain and
subsequently release reference details to perspective employers for their approval prior to employment. GSL will treat all
details supplied in a con fidential and sensitive manner. I undertake to keep all details supplied by GSL in a con fidential
manner. Whilst undertaking work arranged by GSL, I will conduct myself in a manner that is appropriate for my position and
will maintain high quality patient care and professional relationships. I agree that I will read the terms and conditions
before commencement of employment and upon my written acceptance of those terms and conditions agree to abide by them and
all other lawful rules and regulations of the company from time to time in force. |
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