Australia Form Aamc 30 PDF Details

Australia plans to form an Aamc with New Zealand in order to improve security and trade. The two countries have been looking into the benefits of a joint intelligence organization for some time, and officials say the alliance will be finalized by the end of the year. The new agency is expected to help both countries share information more easily and promote trade opportunities. In particular, Australia hopes to strengthen its security relationship with New Zealand in light of increasing threats from terrorism and cybercrime.

QuestionAnswer
Form NameAustralia Form Aamc 30
Form Length7 pages
Fillable?No
Fillable fields0
Avg. time to fill out1 min 45 sec
Other namesNSW, IMG, onfirming, AHPRA

Form Preview Example

* A A M C - 3 0 1 *

AAMC-30

Application for assessment by a medical college

Profession: Medical

Health Practitioner Regulation National Law (the National Law)

This form is for international medical graduates (IMG) who are seeking limited registration for postgraduate training or supervised practice in order to undertake short term specialist training, and require assessment by a medical college as part of that application process.

The purpose of this application is to enable the college to advise the Medical Board of Australia (the Board) on the suitability of the specified training position for the IMG. The Board requires this advice from the college to help decide on the eligibility of the IMG for registration in the specialist pathway

-short term training. This pathway does not lead to specialist registration. Applicants seeking to qualify for specialist registration must be in the specialist pathway - comparability assessment.

For more information, refer to the Board’s registration standard for specialist registration at www.medicalboard.gov.au/registration-standards

This application comprises:

Part A: to be completed by the applicant and the employer/sponsor, and

Part B: to be completed by an authorised college representative

It is important that you refer to the Board’s registration standards, codes and guidelines before completing this application. Registration standards, codes and guidelines can be found at www.medicalboard.gov.au

This application will not be considered unless it is complete and all supporting documentation has been provided. Supporting documentation must be certified in accordance with the Australian Health Practitioner Regulation Agency (AHPRA) guidelines; see Certifying documents in the Information and definitions section of this form.

Privacy and confidentiality

The information collected in this form is authorised or required under the National Law for the purposes of determining an applicant’s eligibility for registration. Information supplied in this form may be provided to other people or agencies as specified in the

National Law. Failure to provide some or all of the information requested may prevent you being registered. AHPRA’s Privacy policy explains how your personal information will be stored, handled and used. The privacy policy outlines how you can access information AHPRA holds about you, and how you may make a complaint if you feel your privacy has been breached by AHPRA.

This document can be accessed at www.ahpra.gov.au/privacy

Symbols in this form

Additional information

Provides specific information about a question or section of the form.

Attention

Highlights important information about the form.

Attach document(s) to this form

Processing cannot occur until all required documents are received.

Signature required

Requests appropriate parties to sign the form where indicated.

Completing this form

Read and complete all questions.

Ensure that all pages and required attachments are returned to AHPRA.

Use a black or blue pen only.

Print clearly in BLOCKLETTERS

Place X in all applicable boxes:

DO NOT send original documents unless specified.

Do not use staples or glue, or affix sticky notes to your application. Please ensure all supporting documents are on A4 size paper.

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.

1.What are your name and birth details?

If you have ever been formally known by another name, or you are providing documents in another name, you must attach proof of your name change.

For more information, see Change of name in the Information and definitions section of this form.

Title*

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

MR

 

 

 

MRS

MISS

MS

 

 

DR

 

 

OTHER

 

SPECIFY

 

 

 

 

 

Family name*

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

First given name*

Middle name(s)*

Previous names known by (e.g. maiden name)

Date of birth

D D / M M / Y Y Y Y

Country of birth

Effective from: 29 November 2013

Page 1 of 7

AAMC-30

* A A M C - 3 0 2 *

 

2.What is your residential address?

When you are not yet practising, or when you are not practising the profession predominantly at one address:

your residential address will be recognised as your principal place of practice, and

the information items marked with an asterisk (*) will appear on the public register as your principal place of practice.

Residential address cannot be a PO Box.

Site/building and/or position/department (if applicable)

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

City/Suburb/Town*

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

Postcode/ZIP*

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Country (if other than Australia)

3.What is your primary medical degree?

Primary medical degree

Title of qualification

Name of institution (University/College/Examining body)

Country

Start date

Completion date

M

M

/

Y

Y

Y

Y

 

M

M

/

Y

Y

Y

Y

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.

4.What is the name of the overseas specialist college/ body awarding the specialist qualification, or with whom are you a specialist-in- training?

Name of specialist college/body

State/Province

Country

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

area (e.g. anaesthetics, neonatology, etc.) in the proposed training position?

Specialist training area

Effective from: 29 November 2013

Page 2 of 7

AAMC-30

* A A M C - 3 0 3 *

 

7.Who is the contact person (employer or sponsor) nominated to act on behalf of the applicant?

Title

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

MR

 

 

 

MRS

MISS

MS

 

 

DR

 

 

OTHER

 

SPECIFY

 

 

 

 

 

Family name

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

First given name

Business hours contact phone number

 

Mobile

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

After hours

Email

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

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

9.In which Australian state or territory will the training position be located?

State or territory of training

VIC

 

NSW

QLD

SA

WA

NT

TAS

ACT

Effective from: 29 November 2013

Page 3 of 7

AAMC-30

* A A M C - 3 0 4 *

 

 

 

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.

Name of applicant

Date

D D / M M / Y Y Y Y

Signature of applicant

SIGN HERE

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

Name of employer/sponsor

Name of institution

Date

D D / M M / Y Y Y Y

Position of employer/sponsor

Signature of employer/sponsor

SIGN HERE

Effective from: 29 November 2013

Page 4 of 7

AAMC-30

* A A M C - 3 0 5 *

 

 

 

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

Page 5 of 7

AHPRA
GPO Box 9958
IN YOUR CAPITAL CITY (refer below)
The relevant capital city will be the city in which the training position is located.

AAMC-30

* A A M C - 3 0 6 *

 

 

 

SECTION F: Specialist college details

11. What are the details of the

specialist college?

Specialist college details

Name of college

Name of contact person

Business hours (phone)

 

 

 

 

 

 

Mobile

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Email

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

Suburb/City/Town

State/Territory (e.g. VIC, ACT)

Postcode

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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.

Name of authorised college representative

Date

D D / M M / Y Y Y Y

Position of authorised college representative

Signature of authorised college representative

SIGN HERE

On completion of the assessment by the college this form and attachments should be sent to:

You may contact AHPRA on

1300 419 495 or you can lodge an enquiry at www.ahpra.gov.au

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

Page 6 of 7

AAMC-30

* A A M C - 3 0 7 *

 

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

Page 7 of 7