RecruitForm | AMA (WA)

Personal Details

Profile image

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Please attach a profile photo.

Name*

Address*

Street Address Suburb Postcode

Email*

Telephone - Home

Mobile*

Work

Date of Birth

Are you a permanent resident/citizen of Australia?*

Yes
No

Skills Checklist

Please indicate positions you have held and areas you have had experience in within the past 5 years.

Computer Software Use

Please indicate areas that you are competent in and have had experience in within the past 5 years.

Microsoft Word
Microsoft Excel
Microsoft Outlook
Best Practice
Genie
Medical Director
Pracsoft
MYOB

Other

Medical Terminology

Work Required

Work Type

Permanent
Temporary
Full Time
Part Time
GP
Specialist

Date available to start work:

Hours of employment you are seeking:

Preferred location for employment:

Temporary Placements Salary Expectations

Permanent Placements Salary Expectations

Driver's license

Yes
No

Own Car

Yes
No

Qualifications

Have you completed any training, education or qualifications including any statements of attainment?

Yes
No

If yes, please indicate below:

Certificate I
Certificate II
Certificate III
Certificate IV
Trade Certificate
Associate Diploma
Advanced Diploma
Degree
Other

Name of the highest Qualification:

Were any of the above qualifications completed while you were an apprentice or a trainee?

Yes
No

If yes, please specify which qualification:

Fitness for Work

The AMA (WA) is an equal opportunities employer and will seek to support reasonable adjustments to accommodate a wide range of employee needs.

Do you have any cold or flu like symptoms?*

Yes
No

If you answered “Yes”, please provide the details below. We will be in contact to organise the next step in the process*

Do you have any condition or any other considerations which could impact on your ability to complete the requirements of this role, or require a reasonable adjustment to be made by the AMA to accommodate?*

Yes
No

Please provide details:*

Criminal Record

Have you ever been convicted of a criminal offence or are you currently the subject of a charge pending before any court?*

Yes
No

Are you prepared to produce a Police Clearance as a condition of being offered employment?*

Yes
No

Privacy Statement

AMA (WA) and its associated entities primary purpose of collecting information you supply on this form is to process your employment application and conduct placement and training related activities. Information may also be used to contact you regarding other recruitment, training, health and community services available, that may be of interest to you. In providing your details you consent to your personal details being used in the manner indicated. Our privacy policy can be viewed online at :

www.amarecruit.com.au

Declaration*

I hereby declare that the information provided by me on this application form is to the best of my knowledge, true and correct.

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