Register as a Doctor
Australian Citizen Unconditional GP

Personal/Contact Details
Last/Family name:
First name:
Preferred name:
Date of Birth (not compulsory):
female male
Telephone (home):
Telephone (work):
Telephone (mobile):
Current Residential Address:
Email address:
Please indicate your preferred method of contact:
Tel (home)  Tel (work)  Tel (mobile)  Fax   Email
Qualification Details
Where did you undertake your primary qualification?
Primary qualification type:
Year of qualification:
Are you currently Vocationally Registered?
yes no no, but in process of obtaining it
Are you currently working?
yes no
Work History
Where you have worked in the last 5 years?
Name of General Practice Suburb & State Date from Date to
Referees (you must have worked with these two people in the last 1-5 years):
Name Relationship (eg colleague, principal, etc) Contact numbers
Current state you are registered in:
Registration Number:
Registered until:
Restrictions/Conditions (if applicable):
Medical Indemnity Details
Indemnity Provider:
Current until:
Work Preferences
State you would like to work in:
City / country area you would like to work in:
Type of work you are seeking:
Are you looking for work as a:
Remuneration Expectations:
Hourly Rate   
Start Date:
Finish Date:
Please indicate any requirements
(such as accommodation, travel, family etc):
How did your hear about us?
If applicable, name of AGPR Rewards member: