GP or Fellow

First name

Last name

Email

Phone

Mobile

Entitlement to work in New Zealand: Are you currently entitled to work in New Zealand?

If you have selected 'Yes' to 'Work Visa, Student Visa or Other' visa type holders, please provide your visa expiry date or other conditional details.

Have you ever been warned, disciplined or dismissed in previous employment for misconduct or performance reasons? If yes, please provide details.

Have you ever been charged with any criminal offence(s) or been convicted of a criminal offence not including any concealed under the Criminal Records (Clean Slate) Act 2004? If yes, please provide details

What professional qualifications/professional licences, or memberships do you have relevant to this position?

Do you have any current or historic physical or mental health conditions (including injuries) that may impact or inhibit your ability to deliver the full remit of this role. If yes, please provide details.

Are you, or any dependent(s), likely to have any material change in location, availability or overall circumstances that may impact or inhibit your ability to deliver the full remit of this role. If yes, please provide details.

What type of driver's license do you currently hold? Please provide details such as NZ Full Driver's License, NZ Restricted License, No License, or Other with the indicated license type and conditions.

Declaration - In submitting this application, you are confirming that the information provided within this application and in any resume or supporting documentation provided, is true and correct, and that you have not omitted any important information that is pertinent to your application or employment with ProCare.Yes

What is your Salary expectation?

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