Australia Form Aamc 30 – Fill Out and Use This PDF

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AAMC-30

Application for assessment by a medical college

Profession: Medical

Health Practitioner Regulation National Law (the National Law)

PART A – To be completed by the applicant and the employer/sponsor

SECTION A: Applicant details

The information items in this section of the application marked with an asterisk (*) will appear on the public register.

Country of birth

Effective from: 29 November 2013

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You must attach an original certified copy of your primary medical degree certificate that indicates completion of a course of study leading to a qualification in medicine.

Attach a separate sheet if all of your academic qualifications and examinations/assessments do not fit in the space provided.

5. What is the specialist

Specialist qualification awarded

qualification awarded (or to be awarded) by the above college/body upon completion of training?

6. What is the specialist training

Effective from: 29 November 2013

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8. What are the employer’s/

Provide your employer’s/institutions’s/supervisor’s contact details below

institution’s/supervisor’s

Please specify:

Employer

Institution

Supervisor

contact details?

Employer’s/institutions’s/supervisor’s name

Site/building (if applicable)

Address (e.g. 123 JAMES AVENUE; or UNIT 1A, 30 JAMES STREET; or PO BOX 1234)

Suburb/City/Town

State or territory (e.g. VIC, ACT)/International province

Postcode/ZIP

Business hours contact phone number

Mobile

After hours

Email

Effective from: 29 November 2013

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SECTION B: Supporting documentation

Please check with the relevant college website as further specific information may be required by some colleges.

Note: Further registration requirements apply, including a signed declaration from the applicant that he/she intends to return home on completion of the training program in Australia.

Please check with the relevant college website for the fee payable to the college to undertake an assessment. This fee may vary from college to college and fee payment must be included with this application form.

Any application form submitted to a college without fee payment will be returned directly to the employer/sponsor to seek payment before an assessment can take place.

It is important that you refer to Curriculum vitae in the Information and definitions section of this form for mandatory requirements of the CV.

The following documents must be attached to this application and submitted to the relevant college:

•position description for the proposed training position

•details of the short term training program in Australia

•signed and dated curriculum vitae of the applicant, and

•for specialists-in-training, a statement from the overseas specialist college or body awarding the specialist qualification with whom the applicant is a trainee in the country of training:

i.confirming your trainee status with the college/body

ii.outlining the content, structure and length of the overseas training program

iii.confirming that you are no more than two years from completing your specialist training

iv.confirming that you have passed a basic specialist examination or satisfactorily completed substantial training (generally three or more years i.e. PGY 5), and

v.identifying the objectives of the short term training to be undertaken in Australia, or

•for internationally qualified specialists, a statement from the overseas specialist college or body awarding the specialist qualification that confirms the applicant’s specialist qualification in the country of training

SECTION C: Consent

Before you sign and date this form, make sure that you have answered all of the relevant questions correctly and read the statements below. An incomplete form may delay processing and you may be asked to complete a new form.

Applicant’s declaration – To be completed and signed by the applicant

I agree to:

•release of the college assessment direct to AHPRA, and

•the employer/sponsor nominated on this form to act on my behalf in matters relating to this assessment.

Employer/sponsor signature – To be completed and signed by the employer/sponsor

Effective from: 29 November 2013

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SECTION D: Checklist

Have the following items been attached or arranged, if required?

Additional documentation			Attached
Section B	Position description for the proposed training position
Section B	Details of the short term training program in Australia
Section B	Curriculum vitae of the applicant
Section B	For specialists-in-training, a statement from the overseas specialist college or body awarding the specialist qualification with
	whom the applicant is a trainee in the country of training:
	i.	confirming your trainee status with the college/body
	ii.	outlining the content, structure and length of the overseas training program
	iii.	confirming that you are no more than two years from completing your specialist training
	iv.	confirming that you have passed a basic specialist examination or satisfactorily completed substantial training (generally
		three or more years i.e. PGY 5), and
	v.	identifying the objectives of the short term training to be undertaken in Australia
Section B	For internationally qualified specialists, a statement from the overseas specialist college or body awarding the specialist
	qualification that confirms the applicant’s specialist qualification in the country of training

PART B – To be completed by an authorised college representative

The applicant must provide the employer/sponsor with a copy of Part B of this form.

SECTION E: Applicant suitability

The Board requires the college to provide the information below. This information will help the Board decide on the applicant’s eligibility for registration in the specialist pathway - short term training.

10. Is the training position/

YES

Go to Section F: Specialist college details

NO

Provide reasons below

program suitable for the
applicant?	Suitability of training position/program

Effective from: 29 November 2013

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SECTION F: Specialist college details

11. What are the details of the

SECTION G: Authorised college representative

The college must attach copies of the documents provided by the applicant for assessment and forward this completed form to the relevant AHPRA office.

Sydney NSW 2001	Canberra ACT 2601	Melbourne VIC 3001	Brisbane QLD 4001
Adelaide SA 5001	Perth WA 6001	Hobart TAS 7001	Darwin NT 0801

Effective from: 29 November 2013

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Information and definitions

CERTIFYING DOCUMENTS

DO NOT send original documents unless specified.

Copies of documents provided in support of an application, or other purpose required by the National Law, must be certified as true copies of the original documents. Each and every certified document must:

•be in English. If original documents are not in English, you must provide a certified copy of the original document and translation in accordance with AHPRA guidelines, which are available at www.ahpra.gov.au/registration/registration-process

•be initialled on every page by the authorised officer. For a list of people authorised to certify documents, visit www.ahpra.gov.au/certify

•be annotated on the last page as appropriate e.g. ‘I have sighted the original document and certify this to be a true copy of the original’ and signed by the authorised officer, and

•list the name, date of certification, and contact phone number, and position number (if relevant) and have the stamp or seal of the authorised officer (if relevant) applied.

Certified copies will only be accepted in hard copy by mail or in person (not by fax, email, etc). Photocopies of previously certified documents will not be accepted. For more information, AHPRA’s guidelines for certifying documents can be found online at www.ahpra.gov.au/certify

CHANGE OF NAME

You must provide evidence of a change of name if you have ever been formally known by another name(s) or any of the documentation you are providing in support of your application is in another name(s).

Evidence must be a certified copy of one of the following documents:

•Standard marriage certificate (ceremonial certificates will not be accepted).

•Deed poll.

•Change of name certificate.

Faxed, scanned or emailed copies of certified documents will not be accepted.

CURRICULUM VITAE

Your curriculum vitae must:

•explain any period since obtaining your professional qualifications where you have not practised and reasons why (e.g. undertaking study, travel, family commitment)

•be in chronological order

•be signed and dated with a statement, ‘This curriculum vitae is true and correct as at (insert date)’, and

•be the original signed curriculum vitae (no faxes or scanned copies will be accepted).

It must also contain all the elements defined in AHPRA’s standard format for curriculum vitae which can be found at www.ahpra.gov.au/cv

Effective from: 29 November 2013

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