Doctor Questionnaire

First Name

Last Name

Email

Phone

Qualifications

Current level at profession:
GP RegistrarHospital RMOMember of the CollegeFellow of the CollegeAssociate ProfessorProfessor

Year in Training:

RMO Year:

In which country do you currently hold full registration with the medical board?

In which country/countries would you like to explore working exposure? (You may select more than one):
IrelandUnited KingdomAustraliaNew ZealandOther:

What type of employment would you like to consider? (You may select more than one):
Short term employment: 6-12 monthsMid-term employment:1- 2 yearsLong term employment: 2 or more yearsPermanent employmentAny of the aboveOther:

How soon would you be looking to start if a suitable match was found for you?ImmediatelyWithin 3 monthWithin 6 monthsOther:

Do you have a preference for city or country?CityCountryEither would be fine

Preferred area of work:
ED Dept at a HospitalGP PracticeHospital Medical officerOther specialty:

Other comment: