LifeFlight Australia

WARNING:

JavaScript is required to view this form. Please enable it in your browser settings.

Find out how

Retrieval Services Queensland (RSQ) Application Form

Instructions

• Please note that this form will expire after 60 minutes. To avoid losing your progress, please have any required information ready before you begin.

• When completing this form, ensure you use the same email address you used to submit your job application to LifeFlight.

• If you have any questions while completing this form, please contact the People & Culture team for assistance via people&culture@lifeflight.org.au or +61 7 3518 2635

* Date Completed (YYYY-MM-DD)

* First Name:

* Surname:

* Email

* LifeFlight Primary Base

* Medical Degree:

* Year achieved:

* Country:

* College Affiliation:

Other: (international speciality Fellow of ICU Sweden)

Training Status:

Estimated Date of Training Completion (YYYY-MM-DD)

Courses Completed (click all courses that apply)

Critical Care experience

Please provide the number of months of Critical Care experience for each area listed below, including the level of experience, as at the current date. If there is no experience at a particular level, please enter 0

Anaesthetics

* Anaesthetics Registrar

* Anaesthetics Senior Registrar

* Anaesthetics Consultant

* Emergency Registrar

* Emergency Senior Registrar

* Emergency Consultant

* ICU Registrar

* ICU Senior Registrar

* ICU Consultant

* Mixed Paeds/ICU Registrar

* Mixed Paeds/ICU Senior Registrar

* Mixed Paeds/ICU Consultant

* Retrieval Registrar

* Retrieval Senior Registrar

* Retrieval Consultant

Australian Medical Board Registration Information

AHPRA Registration Number

Registration Type:

Application to be lodged/in process (international Doctors choose this option)

Resume Status

If your employment history, qualifications, or other career details have changed since you applied for the role with LifeFlight, please upload an updated copy of your resume and ensure that the information provided in this RSQ form reflects your most current resume. If there have been no changes since your application, there is no need to upload your resume again, as we already have a copy on file.

Current Resume

Choose file

* Resume Status Confirmation

New/updated resume uploaded

My resume remains unchanged since my original application

Acknowledgement

* I acknowledge that LifeFlight may collect, use, store, and disclose the information provided in this form for employment, credentialing, compliance, and clinical governance purposes, including submission to Retrieval Services Queensland (RSQ), in accordance with LifeFlight’s Privacy Policy I certify that the information provided in this form is true, complete and correct to the best of my knowledge I understand that providing inaccurate, incomplete or misleading information may impact the credentialing process and may affect my eligibility for employment with LifeFlight Acceptance of the above acknowledgement.

I agree

LifeFlight Administration to Complete

Registrars are allocated to a primary LifeFlight base, within the LifeFlight Retrieval Medicine (LRM) network. However, Registrars may be required to work at other bases in accordance with operational and/or business needs.

Planned Base: Candidates are employed within the LRM system and nominally allocated to a home base while being required to work anywhere within the LRM system as required).

This Registrar meets the required criteria for appointment as a Retrieval Registrar and is acceptable to work in LifeFlight Retrieval Medicine bases. Supervision of Practice will be undertaken by the Clinical Lead (Consultant) at each base.

Notes from LifeFlight

LifeFlight Retrieval Medicine

LifeFlight Employee Name

LifeFlight Employee Signature

Date

Queensland Health RSQ Representative

RSQ Employee Name

RSQ Employee Signature

Date

Approved

Conditionally Approved

Declined

Notes From RSQ: