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Please fill in all mandatory fields marked with an asterisk (*).

Home address:
What is your current notice period? 
Many roles request responses to Skills and Experience. We use this to help us decide how well you meet the job requirements.
A document to answer Skills and Experience for many roles is mandatory. If the job advertisement mentions completing Skills and Experience is mandatory, please upload your responses to here. Alternatively, a document answering Skills and Experience is optional and if completed may help your application to stand out.
If you haven’t yet read the Position Description, you may find it on our 'work with us' page.

The following must be completed in full.
Failure to complete this section of the application will result in the application not being considered.
It is understood you may summarise the details of an individual matter however, failure to declare a matter may result in immediate termination or suspension of any employment.
1. If appointed to the advertised position, is there any issue that may impede you fulfilling the full scope of activities and privileges required of the position? 
2. Have you ever had any limitations or restrictions placed on your clinical privileges or appointment in any previous medical position? 
3. Have there been, at any time in the past or currently, conditions placed on your registration and/or your licence for any reason? Has your registration or licence been cancelled, suspended or in any way revoked?  
4. Has there, at any time in the past or currently, been legal action taken against you alleging negligence, whether or not involving your employer at the time? 
5. Has there been, in the past/currently, any complaint/allegation made to a body established under the law of any state, territory or the Commonwealth which has resulted in an adverse finding against you, or required corrective action to be taken by you? 
These may include, but are not limited to:
Complaints dealt with by the Health Care Complaints Commission (HCCC) or equivalent in other jurisdictions (including complaints made to the HCCC which may have already been referred to investigation and/or resolution).
Complaints alleging discrimination or harassment dealt with by an anti-discrimination body, the NSW Civil and Administrative Tribunal, or other body established under the law.
Complaints of breaches of Work Health and Safety Legislation dealt with by WorkCover, the Industrial Relations Commission or other body.
6. Has there been any criminal conviction against you currently or in the past? 
7. Is there anything further you are required to disclose? 
Declaration
I declare that I have answered all the above questions accurately and I have not withheld any information which might impede me from fulfilling the full scope of activities and privileges applicable to the position.
Where impediments have been disclosed in this document, I have discussed/will discuss these with the appropriate officer of NeuRA.
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