Standard Health Workforce Certificate Application Form

Employer Details

Contact Officer

Position Details

Main Job Location


Secondary Job Location (if applicable)


Practitioner Details

Do you seek certification for a position in which a medical practitioner HAS been identified for visa nomination? *
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Does the practitioner hold an Australian medical qualification as their primary medical degree? * 🛈
Is the practitioner continuing existing employment arrangements with the same employer at the same location? * 🛈


Declaration

I understand that giving false or misleading information is a serious offence, and I declare that the details provided in this form are correct. *
I understand that information I provide will be shared with other bodies responsible for the Visas for GPs initiative, including the Australian Government Department of Health, and Department of Home Affairs, and that all personal information relating to this application is protected by law under the Privacy Act 1988. *