VAPTP-2B Current Victorian Trainee Application 2022

Current Victorian Trainee Application – 2022 DO NOT CHANGE ANY PART OF THIS FORM. FILL IN THE SPACE IN THE BOXES PROVIDED Surname First Name Postal Address (including postcode) Home Phone Number Mobile Phone Number Email address Year of commencing Anatomical Pathology Training Current Appointment Previous appointments in Pathology and number of months acknowledged by RCPA for each position (include exam successes if any) To complete with supervisor: 1. Are there areas in your training that you and your supervisor believe you are currently deficient in, and 2. Will the current appointment assist this (Supervisor to sign): SUPERVISOR’S NAME AND SIGNATURE NAME SIGNATURE DATE 1 I DO NOT wish to transfer (tick) Please sign declaration at end of document. NO further parts of this document need be completed. I DO wish to transfer (tick) Please continue. Reason for requesting transfer Comments for consideration including reasons why certain laboratories are NOT preferred. Referees Name, full address, contact numbers, email address of two referees (must be consultants and Referee 1 must be your current supervisor) with whom you currently work: Referee No 1 (Must be current Supervisor) Surname First Name Current Appointment Work Phone Number Mobile Phone Number Email Address Referee No 2 Surname First Name Current Appointment Work Phone Number Mobile Phone Number Fax Number Email Address 2 APPLICANT’S PREFERENCES Please number ALL institutions, in order of your preference (please note that many of these appointments will include rotations to other laboratories – for details, discuss with relevant Heads of Department). Registrars who do not complete the form do so at their own risk. Please note: As this is a matching process it is in your interest to contact these laboratories and take part in their own recruitment process as they remain the employing authorities. The Alfred Hospital Austin Health Australian Clinical Labs, Bendigo Base Hospital Australian Clinical Labs, Clayton Australian Clinical Labs Geelong Cabrini Health, Cabrini Hospital Pathology Dorevitch Pathology, Albury Dorevitch Pathology Ballarat Hospital Dorevitch Pathology Frankston Hospital Dorevitch-Gippsland Pathology, Latrobe Regional Hospital, Traralgon Dorevitch Pathology, Heidelberg Dorevitch Pathology, Western Hospital Eastern Health Pathology, Box Hill Hospital Melbourne Pathology, Collingwood Melbourne Health Shared Pathology Service, Royal Melbourne Hospital Southern Cross Pathology Australia, Monash Medical Centre Peter MacCallum Cancer Centre Royal Women’s Hospital and Royal Children’s Hospital St Vincent’s Hospital Victorian Institute of Forensic Medicine 3 PROCEDURES TO BE FOLLOWED BY APPLICANT CHECKLIST – SUBMISSION of DOCUMENTS 1. Application form Only if transfer is requested, then also include 2. Curriculum Vitae 3. Referee Reports (document VAPTP-2F) 4. Most recent Competency Form (VAPTP-5B) Please submit applications electronically ONLY to: Aleen Nazaretian Administrative Assistant, Victorian Anatomical Pathology Training Program The Royal College of Pathologists of Australasia Email: [email protected] Applications close Friday 30th July 2021 APPLICANTS ARE REMINDED THAT THEY WILL NOT BE CONSIDERED FOR TRANSFER WITHIN THE TRAINING PROGRAM IF THEY FAIL TO STRICTLY ADHERE TO THE ABOVE PROCEDURES. PLEASE NUMBER ALL INSTITUTIONS YOU WILL BE NOTIFIED WHEN BOTH REFEREE REPORTS ARE RECEIVED BUT IT IS YOUR RESPONSIBILITY TO ENSURE ALL RELEVANT DOCUMENTATION HAS BEEN SENT. THE VICTORIAN ANATOMICAL PATHOLOGY TRAINING PROGRAM ACCEPTS NO RESPONSIBILITY FOR INCOMPLETE DOCUMENTATION RECEIVED. The Match will most likely be held 8th September 2021. You will be notified of the result. If you have any queries concerning the transfer process contact Aleen Nazaretian on [email protected] APPLICANT’S DECLARATION If appointed I agree to observe all hospital by-laws, regulations and rules. NAME DATE 4 .

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