app_gp_terms

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GP Registrars Application for GP Terms:

To apply for GP Terms in the Northern Territory fill in the form below and send to the Programs Coordinator or alternatively download a copy of a PDF version print and fax to:
Suzanne Bergin fax: 08 8946 7079

Application for GP Terms 2008 >>>
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Year:
ALL APPLICANTS:
Name:
Ph: (wk)
Ph: (hm)
Current Address:
Please provide CV as at the start of this period
INTERSTATE APPLICANTS ONLY:
Future NT Address if known:
In addition please provide:
Medical Reference from Consultant or Supervisor
An outline of your long term plans
Have a look at the placements available
I am interested in the following placements:

	Jan - April	April - July	July - Oct	Oct - Jan
1st pref.
2nd pref.
Type of Term
Will you be:			If Part Time how many sessions?
This will be emailed to GPR Program Manager. You will be sent a receipt
In view of the long term planning required in remote areas to get staff, we will only accept this application on the grounds you are willing to undertake this term. remember that you need to get 2 AMSN points during training Closing Date: