Doctors Registration

Registration Form

All fields marked with * are required.

Personal Information

First Name *

Surname *

Primary Email *

Confirm Email *

Mobile Phone *

Home Phone

Work Phone

Application Details

Please select from the list below the type of work you are interested in *

Specialty / Grade Preference

Available From

Available To

Available From

Available To

Available From

Available To

Please attach your CV here
(select your CV by clicking on the browse button, then hit Upload)

Do you give us permission to contact your referees to get referee assessments? [These will be sent to prospective employers with your CV to assist with your application.] *

Yes No

Do you give us permission to circulate your CV and details to suitable clients in order to gain expressions of interest in your services? *

Yes No

Please choose where you would prefer to work *

New Zealand

Australia

Either

If you wish to provide further details about your application please do so below

I have read and agree to Triple0’s privacy policy *

Career Details

In which country are you currently working as a doctor? *

In which country did you obtain your primary medical degree? *

Additional Information

Where did you hear about us *

Other (please specify)

If you were referred by a colleague, what was his/her name

Refer a Friend

Do you have any friends or colleagues you would like to refer to Triple0?

Click here to see our Refer a Friend incentives

Friend's Name

Contact Number

Friend's Name

Contact Number

Newsletter & Rewards Programme

Would you like to receive the Triple0 Newsletter?

Yes No

Would you like to sign up to the Triple0 Rewards Programme?

Yes No

"We could not believe our ears when my mobile phone rang moments after having submitted our details" Dr Jenine Edward

Doctors Registration

Registration Form

"We could not believe our ears when my mobile phone rang moments after having submitted our details"
Dr Jenine Edward