DJS sponsorship form (Long stay visa)

Personal details
Title:
First Name:  *
Last Name:  *
Date of birth:  *
Gender: Male   Female
Nationality:  *
Passport Number:  *
Passport Expiry Date:  *
Do you speak any languages other than English?
Dependents' details
Your partner and children can be included on your visa as dependents
Name Relationship Nationality Gender Date of Birth
1:
2:
3:
4:
Mailing address
Street:  *
Suburb / Town:  *
State:  *(only if country is Australia)
Postcode:  *
Country:  *
Contacts
Business:  *
Home:
Mobile:
Fax:
Email:
Preferred contact:
(to select multiple options press control/command & click again)
Are you presently using the services of another agency? YES   NO *
Are you already in discussions with any Australian employers? YES   NO *

If yes please specify:
How did you learn about Dentist Job Search?
Professional details
Are you? Right handed   Left handed   Both *
Do you have professional indemnity? YES   NO   WILL ARRANGE  
Are you a member of the BDA or other professional associations? YES   NO  
If other please specify:
Qualifications
Details:
(Please include the year and university. Also include ADC qualifications if relevant.)		  *
Particular skills or interests in dentistry
Details:
Previous experience
Details:
(Please include dates, position held, location and whether govt. or private)		  *
Referees
Must be dental professionals - Where posssible please include written references
Name Relationship Email Phone
1:  *  *  *  *
2:
3:
Availability
Permanent
From:  *
To:  *
Hours: It is a requirement of the Department of Immigration and Multicultural Affairs that all visa sponsored dentists are nominated to a full time position of approx 39 hrs per week.
Appointment details
Please Note:
State capital cities (Sydney, Melbourne, Brisbane, Perth, Adelaide) are over supplied with dentists and jobs that are available are usually very highly contested. As a result only a few exceptional locum requirements or difficult to fill positions may be available in the state capital cities.
Acceptable localities
(Please indicate how far you are willing to travel):		  *
Individual details
These paragraphs will be incorporated into your introductory CV
Why did you choose a career in dentistry?
What are your personal goals?
What attributes and contributions could you make to a work place?		  *
Hobbies and interests outside dentistry:
Other information
Details:
(Include study, travel etc)
Attach personal resume
Select file to upload:
(DOC, DOCX and PDF formats only.
Size limit: 300 KB.)
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VIC, metro, permanent
QLD, metro, permanent
NSW, country, locum
QLD, metro, permanent
ACT, metro, permanent
NSW, coastal, permanent
QLD, coastal, permanent,locum
NSW, coastal, permanent,locum
NT, country, permanent,locum
ACT, metro, permanent
VIC, metro, permanent
VIC, country, permanent
NSW, coastal, permanent
ACT, metro, permanent
NSW, country, permanent
QLD, coastal, permanent
QLD, metro, permanent
NSW, coastal, permanent
QLD, coastal, permanent
WA, country, locum
QLD, metro, permanent
NZ, country, permanent
NZ, metro,country, permanent
VIC, metro, permanent