Application Form – ADI Volunteer Papua New Guinea Please complete this form and email to ADI with a copy of your current CV.
Please select the role(s) you wish to apply for: Volunteer Medical Officer Papua New Guinea
Volunteer Health Manager Papua New Guinea
Personal Details
Title: Family Name: Given Name:
Street Address: __
State: Postcode: __
Phone contacts: Home: Work:
Mobile : Email:
Nationality:
I am a citizen or have Permanent Resident status in Australia New Zealand or PNG
Hobbies and interests:
What length of assignment is of interest? 5 – 6 months 11 – 12 months
What is your availability over the next two years?
How did you hear about ADI?
Medical Officer Applicants Only
Year of Qualification: Medical Specialty:
Medical Registration Number: State:_____
Medical Indemnity Provider:
Post: P.O. Box 954, Manly NSW 1655 Fax: (02) 8966 9594 Email: [email protected] Health Manager Applicants Only
Qualification(s) Held: ______Area of Specialty/Interest: ______
Years of Clinical Experience: ______
Cross-cultural Experience (location/time): ______
Referees (ADI will not contact referees without your permission) Please provide the names and details of three referees for your professional work.
Title: Family Name: Given Name:
Street Address:
State: Postcode:
Phone: Work: Mobile: Email:
Current position: Professional relationship to you:
Title: Family Name: Given Name:
Street Address
State: Postcode:
Phone: Work: Mobile: Email:
Current position: Professional relationship to you:
Title: Family Name: Given Name:
Street Address
State: Postcode:
Phone: Work: Mobile: Email:
Current position: Professional relationship to you:
Post: P.O. Box 954, Manly NSW 1655 Fax: (02) 8966 9594 Email: [email protected] What are your motivations for applying for a volunteer role in PNG?
Please give details of any previous volunteering experience
What qualities and capabilities do you feel you can bring to the role you are applying for?
Post: P.O. Box 954, Manly NSW 1655 Fax: (02) 8966 9594 Email: [email protected]