tel: +44 (0)28 9059 0077

UK free: 0800 052 3285

fax: +44 (0)28 9059 0088

UK free: 0800 052 0106

Direct Medics

Locum Recruitment

Register

To register with Direct Medics is simple. We need your:

Curriculum Vitæ;
Hepatitis B Certificate;
GMC Certificate;
Passport/Visa status if applicable;
A completed application form - only takes 5 minutes:
- Complete the on-line form below:
- Or fax it to us:
  - UK Free Fax: 0800 052 0106;
  - Irish Republic Fax: 048 9059 0088
  - Elsewhere: 004428 9059 0088
Or post it to us:
- Direct Medics
- Locum Recruitment
- 65 Eglantine Avenue
- Belfast, BT9 6EW
- NORTHERN IRELAND

Personal Details

Title*:

Surname*:

Forenames*:

Maiden Name:

Date of Birth*:

Nationality*:

Gender*:

Street Address*:

Town/City*:

Post/Zip Code:

Country*:

Permanent Address (If different from above)

Street Address:

Town/City:

Post/Zip Code:

Country:

Home Phone*:

Work Phone:

Mobile:

Bleeper:

Email:

GMC Details, National Insurance & Eligibilty

GMC Number:

GMC Type:

Valid To: dd/mm/yyyy Click Calendar

Nat. Ins. No.:

Please confirm your eligibility to work in the

UK and Ireland:

Permit expiry date: Click Calendar

Other details if

required:

Locum Work Required

Grades* (at least 1):

Consultant Clinical Assistant

Associate Specialist Registrar

Staff Grade SHO

Specialist Registrar House Officer

Specialities*:

Accident & Emerg. Obs & Gynae

Anaesthetics Onocology

Cardiology Ophthalmology

Cardiothoracic

Surgery Orthopaedics

Dermatology Paediatrics

ENT Paediatric Surgery

General Medicine Plastic Surgery

Genitourinary

Medicine Psychiatry

Geriatric Medicine Radiology

Maxillo-facialRespiratory

Surgery Medicine

Nephrology Rheumatology

Neurology Surgery

Neuro Surgery Urology

Other

Brief summary of

qualifications:*

When are you available to work?*

Evenings/Days:

Evenings Weekends

Odd Days

Holidays:FromTo

Period 1

Period 2

Period 3

Full-time: From To

Period 1

Period 2

Period 3

Part-time: Recurring weekdays

MTWTF

Select Days

Further information

(work):

Areas Willing To Work In*

Select all that apply: Order of preference if any

North East Set the same

North West value to

Midlands indicate equal

London preference or

South East leave unset

South West

N. Ireland

Ireland

Scotland

Wales

Further information

(areas):

References

Please state the names of two recent referees and if convenient include their telephone and/or fax numbers:

Name 1:

Hospital 1:

Town/City 1:

Post/Zip Code 1:

Country 1:

Telephone 1:

Fax 1:

Name 2:

Hospital 2:

Town/City 2:

Post/Zip Code 2:

Country 2:

Telephone 2:

Fax 2:

How Did You Hear About Us?

Please indicate:

Details if required:

>>Top

Register

General:

Doctors:

Health Trusts & Employers:

Doctors Only

All Grades & Specialities

Excellent Rates Of Pay

Travel Expenses Reimbursed

Work Permits Arranged