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Generalist Emergency Medicine application form

Instructions

If you are applying for RPL, you will need to submit a completed ACRRM Proforma CV. This can be downloaded here.

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

Certificates (relevant to your GEM training)

Please upload certificates of completion or proof of enrolment in any compulsory courses for your GEM
5MB limit

Curriculum Vitae

Current CV
Please upload a current version of your CV. 5MB limit.

Training post

Details of your training post application

You will need to fill out an application for post accreditation.

Download Application for post accreditation

 

Post application
Please upload your completed Application for Post 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 or Recognition of Training Time since Individual Bridging Plan Issued?

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
  • Letter demonstrating clinical privileges at a local hospital

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

Completed ACRRM Pro Forma CV
Please upload your completed ACRRM Pro Forma CV (this template can be downloaded from the top of this form)
Evidence of employment and satisfactory performance in each position for which you are applying for recognition:
Any further evidence you wish to upload
5MB limit per file

Payment, declaration, indemnity & privacy notice

Declarations & payment

Payment method



Total cost:
AUD $1284

Card type

Please enter your 16 digit card number with no spaces
mm/yy
Authorisation

Payments can be made out to the following details:

Account Name ACRRM
BSB 034 003
Account Number 264 808
Reference GEM<Your Name>
eg: GEM 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 rely 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
Today's date

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

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.
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