Hospital registration form

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Where can I work?

State

Postcode

or Suburb

Distance

Please fill in this form to register your locum vacancy with LML Medical Recruitment.

* Required field

Hospital details

Hospital / clinic name:*
Address:*
Suburb:*
State:*
Postcode:*
Area health service name:
Area health service ABN:*
Phone number:*
Fax number:*
Hospital / clinic description:

Contact person

Locum details / benefits

Payment method:
Indemnity insurance provided	Comment
Accommodation provided	If yes, please provide details and special instructions if any
Travel provided	If yes, please provide details of travel allowance
Medical registration reimbursement
Vehicle usage	if yes, please state any usage conditions

File upload

Attach current vacancy list:

Vacant position description 1

Vacant position description 2

Verification Code

Verification Code*

Enter the code shown: