DJS | Dentist Job Search - Job seeker registration form

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Position: DENTIST GP
State: Victoria
METRO, PERMANENT, PT

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Job seeker registration form

If you are already registered with DJS, you may use this form to update your details.

Once registered you may use our employee service as often as you wish - no placement fees apply.

Note: Please complete form accurately and in full. Details entered will be used to create an introductory profile to promote you to employers.

Personal details
Are you already registered with DJS?	YES NO
First name:	*
Last name:	*
Date of birth:	*
Gender:	Male Female
Do you speak any languages other than English?

Mailing address
Street:
Suburb / town:
State:	(only if country is Australia)
Postcode:
Country:

Contacts
Please provide at least one method of contact.
Business:
Home:
Mobile:
Fax:
Email:
Preferred contact: (For DJS and potential employer contact)	* (to select multiple options press control/command & click again)
Are you presently using the services of another agency?	YES NO *

Professional details
Do you have professional indemnity?	YES NO WILL ARRANGE
Are you a member of the ADA or other professional associations?	YES NO
Are you a member of other professional associations?	YES NO If yes please specify:
I am registered with the following dental boards:	(to select multiple options press control/command & click again)
Professional development / Further education

Eligibility
Are you an Australian citizen / resident?	Citizen Resident NO *
Are you a New Zealand citizen / resident?	Citizen Resident NO *
If you are not an Australian or New Zealand citizen/resident, what visa do you plan to use in order to work in Australia?

Qualifications

Anticipated qualifications if graduate.

Please include ADC qualifications if relevant.

	Institution	Year	Degree attained
1:	*	*	*
2:
3:
4:

Particular skills or interests in dentistry
Details:	*

Work experience

Please include dates, position held, location and whether government or private. Please order with most recent experience on top. For a new graduate include any work experience outside of dentistry.

	Dates eg: Jan 2002 - Mar 2003	Practice eg: Dr Smith, Private Practice	Location eg: Sydney NSW
1:	*	*	*
2:
3:
4:

Years of clinical dental experience:

Awards and prizes received

Only complete if recent graduate.
Please only put awards and prizes relevant to your dental career.

	Year	Award
1:
2:
3:
4:

Referees

Must be dental professionals.
Please include area codes for all phone numbers.

	Name	Relationship	Email	Phone
1:	*	*	*	*
2:
3:

Availability
From:	*
To:
Other:

Appointment details

Acceptable localities (Please indicate how far you are willing to travel):

	Country	State	Specifics
1:	*	*	*
2:
3:
4:
5:
6:
	I would like to receive email updates when a new job gets added in a state I am interested in.

Type of work:

Full Time Part Time Permanent Locum *

Type of practice:

Private practice Government clinics *

Salary expectations:

Available days

Other information
Details: (Include study, travel etc)

How did you hear about us?

Free monthly e-newsletter subscription
	Please check this box if you would like to be subscribed to Prime Practice's E-Newsletter (only for registrations that include an email address).