Submit Application
Wulff Medical Consulting is committed to providing conscientious and individual services to Candidates. To achieve this, we require applicants to complete this Registration Form with particulars regarding themselves, their employment preferences and residency status. Basically, any information that may affect your employment, but may not be contained in your curriculum vitae. There is room at the end for you to include anything else you think we may need to know. Thank you for your cooperation.

Personal Information
A star (*) denotes a required field

*
Family name (as it appears on your passport):
*
Given name(s):
*
Gender:
*
Date of Birth (dd/mm/yy):
*
Current residential address:
*
Phone number (with country code):
*
Primary e-mail address:
Alternative e-mail address:
*
Citizenship(s):
Passport number:
Passport expiry (dd/mm/yy):
Marital status:
Partner's occupation:
*
Australian residency status:
Visa subclass:
English language proficiency
Complete at least one section

IELTS
Date (dd/mm/yy):
Overall score:
Listening score:
Reading score:
Writing score:
Speaking score:

OET
Date (dd/mm/yy):
Listening score:
Reading score:
Writing score:
Speaking score:

PLAB
Date (dd/mm/yy):

NZREX
Date (dd/mm/yy):

Secondary Education
only applicable if instruction was in English and completed in Australia, Canada, Republic of Ireland, New Zealand, South Africa, United Kingdom, or United States of America, AND your tertiary medical qualifications were also completed in one of these countries

Year of Graduation:
Name of School:
Country:
Clinical Experience
Basic degree
Title:
Institution awarding the qualification:
Country:
Date of graduation (mm/yy):

Internship training
Country:
Date of completion if not included in qualification (mm/yy):

Specialist training
Discipline:
Institution awarding the qualification:
Country:
Date of commencement (mm/yy):
Date of completion (mm/yy):

Australian Medical Council
Please check which applications you have commenced and/or completed

AMC/MCQ examination
Completed:
Date (mm/yy):

Clinical examination
Completed:
Date (mm/yy):

Certificate of Advanced Standing
Commenced:
Completed:
Date (mm/yy):

Specialist Assessment
Commenced:
Completed (including college assessment):
Date (mm/yy):

General Employment Questions
Yes *
No
Do you have any past or current medical or disabling conditions that may affect your ability to safely and adequately perform the requirements of medical employment?:
If yes, please specify:
Yes *
No
Are you willing to undergo a police records check for pre-employment safety screening purposes?:
Yes *
No
If required, are you willing to undergo a 'Working with Children' check?:
Yes *
No
Have you been charged, convicted or found guilty of an offence of any nature in Australia or overseas?:
If yes, please provide details of any offences with dates:
Yes *
No
Have any conditions or restrictions been imposed on your professional medical licence or registration with any authority in Australia or overseas?:
If yes, please provide details with appropriate dates:
Employment preferences
*
Current level of appointment:
What level are you seeking next?:
*
Discipline (eg, Orthopaedics):
*
Intended start date in Australia (mm/yy):
*
How much notification time your current employer requires:
Where you would like to work in Australia and why:
Additional information
Please provide any additional information you think we may need

Curriculum Vitae
Microsoft Word documents preferred

Please attach your curriculum vitae:
Submit