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AST Outside of Training Application

Instructions

Please ensure you have a completed AST Pro Forma CV ready to upload.

If you are applying for training post accreditation as well, please ensure you have a completed AST Application for Accreditation form ready to upload.

Please ensure you have read the AST Program How to Apply Guide

E.g. Dr, Mr, Mrs
If you are an ACRRM member, please provide your membership number above.

AST (Advanced Specialised Training)

Please select an AST Discipline. If you are unsure which discipline you wish to seek recognition for, choose unsure

Applicants choosing either Aboriginal and Torres Strait Islander Health, Population Health or Remote Medicine will need to submit an AST Project Proposal form, available here.

AST Project Proposal
AST applicants in ATSIH, Population Health or Remote Medicine, please upload your completed AST project proposal form. Please see the AST curricula for further information.
Certificates of completion / Proof of enrolment
Please upload any certificates of completion or proof of enrolment in any compulsory courses for your AST. 5MB limit. Please see the AST curricula for further information on courses.

Curriculum Vitae

Please see the AST Pro Forma CV link at the top of this form.
Completed AST Pro Forma CV
Please upload your completed ACRRM AST Pro Forma CV (this template can be downloaded from the top of this form). Please be sure to rename the file to include your name for clarity.
Current CV
Please upload a current version of your CV. Please be sure to include your name in the filename for clarity.

Training post

Details of your training post application

You will need to upload a completed AST application for accreditation form.
Post application
Please upload your completed AST Application for Accreditation.
Please provide the name of your supervisor.
Please provide the name of the post

RPL / Evidence

Are you applying for Recognition of Prior Learning?

Please provide to ACRRM:

Verification of employment through providing one of the following:

  • Hospital record of employment including rotations covered
  • Statement of service
  • Letter from employer confirming length of employment, patient numbers, demographics and diagnostic cetergories for applicants in VMO positions
  • Verification of Clinical Experience using the ACRRM AST Pro Forma CV
  • Letter demonstrating clinical privileges at a local hospital

 Confirmation of satisfactory performance in clinical work through one of the following:

Evidence of employment and satisfactory performance
Please upload evidence of employment and satisfactory performance in each position for which you are applying for recognition

Payment, declaration, indemnity & privacy notice

Declarations & payment

Payment method


Total cost:
AUD $1322
Price incudes GST

Card type

Please enter your 16-digit card number
mm/yy
Authorisation

Payments can be made out to the following details:

Account Name ACRRM
BSB 034 003
Account Number 264 808
Reference AST<Your Name>
eg: AST John Smith
Declaration

Please call ACRRM on +61 7 3105 8200 with your credit card details to process your payment.

Declaration

Indemnity

I acknowledge that the Australian College of Rural and Remote Medicine (ACRRM) will reply upon the accuracy and truth of the statements and information that I provide in this application in order to assess my prior experience. I hereby indemnify ACRRM and will keep ACRRM indemnified for any loss, cost or expense incurred by ACRRM as a result of any claim, action, demand or proceeding brought by any person in respect of loss or damage arising from any false, misleading, or inaccurate statement or information provided by me in this application.

I also undertake to provide all details of any current or pending investigations, review, inquiry or sanction by the Australian Health Practitioner Regulation Agency, Professional Services Review Director, Medicare Australia or any similar body in relation to my professional practice or behaviour in Australia.

Indemnity
Please upload any documentation relating to any pending investigations, review, inquiry or sanction.
5MB limit

Applicant Declaration

I declare that the information provided by me regarding this application is true and accurate. I recognise that it is my responsibility to provide all necessary supporting documentation. I acknowledge that ACRRM reserves the right at any stage to reverse any decision regarding this application made on the basis of incorrect or incomplete information.

Declaration
Today's date

Privacy Notice

In complying with the National Privacy Principles, ACRRM will only collect personal information that is relevant to its primary purpose of providing vocational training programs and services. Please note that ACRRM may need to at times contact you via email, phone or SMS to discuss your application and at times may need to disclose your information to a third party but will only do this for the primary purpose for which it was collected, or for a directly related secondary purpose. Should ACRRM need to use your information for any other purpose, we will seek your prior consent. ACRRM will take all reasonable steps to protect personal information from misuse, loss and unauthorised access or modification. You may gain access to the information ACRRM holds about you at all reasonable times by contacting ACRRM's Training Team.

Please do not enter anything here.