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GP Locum Registration Form

Are you interested registering as a GP Locum?

Once registered, you will receive a fortnightly e-bulletin, which details upcoming GP locum opportunities.

Please complete and submit the registration form below. We will review your application and contact you if we require more information.

"*" indicates required fields

DD slash MM slash YYYY
Name*
DD slash MM slash YYYY
Email*
Address*

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Australian residency status*
Are you vocationally registered in Australia?*
Do you require a 19AB exemption when applying for a Medicare provider number?*
Have you previously been credentialed at a Western Australian hospital?*

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What type of locum work are you interested in? Tick one or more if applicable*
Have you undertaken Aboriginal cultural training or had experience working in a Aboriginal Community Controlled Health Service?*

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Max. file size: 128 MB.
This field is for validation purposes and should be left unchanged.