Dentist job seeker registration form

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Position: DENTIST GP
State: Queensland
METRO, PERMANENT, FT

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Dentist 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
Have you previously been 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 insurance?	YES NO WILL ARRANGE *
I am registered with the following dental boards:	*(to select multiple options press control/command & click again)
I have a radiation licence in the following states:	(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.

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

Particular skills or interests in dentistry
Maximum 500 characters.
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:

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 / Notice Required:

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 *

Available days

Individual details
This information will be incorporated into your introductory CV. Maximum 500 characters.
Personal Paragraph (Why did you choose a career in dentistry? What are your personal goals? What attributes could you bring to a work place?)

Other information
Maximum 500 characters.
Any other relevant information: (e.g. study, travel etc that might impact on availability, can only work in left handed practice)

How did you hear about us?

DJS seasonal update and special offers
	I would like to be subscribed to receive DJS seasonal update and special offers (only for registrations that include an email address).