Registration

ELS Locum Registration Form

Locums take a rural break…….and get paid!

Be part of a new rural emergency locum service and Pharmacy Guild initiative.

If you are a Pharmacist

If you want great pay

If you can get away for a maximum of 7 days

Then you can be an emergency rural locum.

Get to see parts of Australia you only ever dreamed of visiting and be part of a long overdue community service helping fellow pharmacists to cope when an emergency occurs

  • Nothing to organise just pack your bag
  • Travel and accommodation all organised and paid for
  • Take a break; it’s practically an outback holiday with top pay

Just fill in the form below & return to signify your interest and we’ll ring you.

I'd like to be an ... "Emergency Rural Locum"
*First Name:
*Last Name:
Address:
State:
Postcode:
Home Phone:
Business Phone:
Mobile Phone:
*Email:
Date of Birth:
Nominated Months
Please nominate in order of preference (1,2,3...) which month or months best suit you to get away and act as an emergency locum
 
December 2019
January 2020
February 2020
March 2020
April 2020
May 2020
June 2020
Can you leave for an emergency post in 24 hours? Yes    
No    
Not sure. I need more detail    
QCPP Accredited Yes    
No
Registration Numbers: PHA
Do you have an ABN? Yes    
No
Curriculum Vitae
Please attach a copy of your current CV:
(We only accept MS Word and Adobe PDF documents,
max file size 10MB)
Please attach a current photo:
(We only accept JPEG and TIFF files)
I have read and understood the
terms and conditions below.
I agree
I do not agree