Agpt application program leave
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- Navigate this page:
- Registrar details
- Reason/s for seeking leave
- Detail the Regional Training Organisation’s efforts to locate a placement (if applicable)
- Regional Training Organisation declaration
- Privacy Statement
AGPT APPLICATION - PROGRAM LEAVE
PurposeThis application is a registrar who is seeking leave from the Australian General Practice Training Program as per the AGPT Program Leave Policy 2017. InstructionsThis application can be filled out electronically or handwritten. Please ensure the declarations on page two of this application are signed by the registrar and Regional Training Organisation. The Regional Training Organisation is to submit this application to the Department of Health on the registrar’s behalf. Submissions from the registrar without Regional Training Organisation approval on page two of this application will not be accepted by the Department of Health. IMPORTANT: All sections of this application must be completed. Please give consideration to providing supporting documentation/evidence with your application.
First name: Surname: AGPT Registrar number: Email: Mobile number: Regional Training Organisation name: Dates seeking leaveStart: End:
Type of leave (Please mark)☐ Exception to the AGPT Program Leave Policy 2017 ☐ Category 2 leave – where the Regional Training Organisation is unable to place registrar Reason/s for seeking leave
Reason/s Regional Training Organisation was unable to place the registrar (if applicable)
Detail the Regional Training Organisation’s efforts to locate a placement (if applicable)
Registrar declarationI declare I have discussed this proposal with my Regional Training Organisation and agree to the application for an exception to the AGPT Program Leave Policy 2017. I declare the information provided in connection with this application is true and correct. Signature: [Registrar to sign] Print name: Date:
I declare we have discussed this proposal with the above mentioned registrar and support this application for an exception to the AGPT Program Leave Policy 2017. I declare the information provided in connection with this application is true and correct. Signature: [CEO or delegate to sign] Print name: Date:
LodgementThe Regional Training Organisation is to lodge this application to the Department of Health on behalf of the registrar. Please email the completed application and supporting documentation to the Department of Health for consideration at AGPTManagement@health.gov.au Privacy StatementYour personal information is protected by law, including the Privacy Act 1988, and is being collected by the Department of Health for the purpose of administering the Australian General Practice Training Program. If you do not provide this information, the Department will be unable to manage your training. You can get more information about the way in which the Department will manage your personal information, including the Department’s privacy policy available on the AGPT website. Directory: wp-content -> uploads -> 2017 2017 -> Leadership ohio 2017 -> Ascension Lutheran Church Counter’s Schedule January to December 2017 2017 -> Board of directors juanita Gibbons-Delaney, mha, rn president 390 Stone Castle Pass Atlanta, ga 30331 2017 -> Military History Anniversaries 16 thru 31 January Events in History over the next 15 day period that had U. S. military involvement or impacted in some way on U. S military operations or American interests 2017 -> The Or Shalom Cemetery Community Teaching on related issues of Integral 2017 -> Ford onthult samenwerking met Amazon Alexa en introduceert nieuwe navigatiemogelijkheden van Ford sync® 3 met Applink 2017 -> Start Learn and Increase gk. Question (1) Name the term used for talking on internet with the help of text messege? 2017 -> Press release from 24. 03. 2017 From a Charleston Car to a Mafia Sedan 2017 -> Tage Participants 2017 -> Citi Chicago Debate Championship Varsity and jv previews Download 9.29 Kb. Share with your friends:
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