If so, on what date? Tertiary qualifications Name of degree/qualification Year obtained Current APS employment details (if applicable) Current APS Agency: AGS No: Classification: Employment Status: Diversity Information (for statistical purposes only) Age: 16-24 25-34 35-44 45-54 55+ Do you have a disability? Yes No Do you identify as an Aboriginal or Torres Strait Islander? Yes No Are you from a non-English speaking background? Yes No If you require any special equipment or assistance to attend an interview or complete a work sample test, please provide details: Specialist experience Please detail any experience as a medical specialist, including the total number of years experience. Medical/Professional Specialty Years Experience Any other relevant professional experience: Medical registration Australian National Medical Registration Number: Declaration
If so, on what date? Tertiary qualifications Name of degree/qualification Year obtained Current APS employment details (if applicable) Current APS Agency: AGS No: Classification: Employment Status: Diversity Information (for statistical purposes only) Age: 16-24 25-34 35-44 45-54 55+ Do you have a disability? Yes No Do you identify as an Aboriginal or Torres Strait Islander? Yes No Are you from a non-English speaking background? Yes No If you require any special equipment or assistance to attend an interview or complete a work sample test, please provide details: Specialist experience Please detail any experience as a medical specialist, including the total number of years experience. Medical/Professional Specialty Years Experience Any other relevant professional experience: Medical registration Australian National Medical Registration Number: Declaration