Australian Doctors International – Application Form

Personal Details
Please select the role(s) you wish to apply for:*
- Doctor or Nurse for patrols
- Health Manager
- Clinical Nurse educator
Please check one or more of these options.
Title*
First Name*
Last Name*
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Home Phone
Work Phone
Mobile Phone
Email*
Nationality*
I am a Citizen or have Permanent Resident status in:
- Australia
- New Zealand
What length of assignment is of interest?
- 5-6 months
- 11-12 months
- Other - please speficy below
Please state specific preferred length of assignment
What are the dates of your availability over the next two years? - (click + to add more rows)
How did you hear about ADI?
Please upload your Resume*
Drop files here or

Accepted file types: doc, docs, docx, pdf, jpg, png, gif.
Doctor or Nursing only
Qualification + Year of qualification - (click + to add extra rows)
Medical Specialty
Medical Registration Number
Medical Registration State/Country
Medical Indemnity Provider
Health Manager Applicants Only
Qualification(s) held: - (Click + to add extra rows)
Area of Specialty/interest
For all Applicants
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?

Personal Details