For Ministry Use Only
DATE
FILE
TRIM
LHD
AON No.

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APPLICATION FORM AND CHECK LIST

NEW AREA OF NEED GENERAL PRACTITIONER POSITION

Please note that applications for a facility yet to open or for a position not yet available will not be considered.
Applications for multiple identical positions based in the same facility are also generally not approved.
SECTION 1 – DETAILS OF CONTACT PERSON FOR THE PROCESSING OF THIS APPLICATION
NAME
ROLE
ORGANISATION
POSTAL ADDRESS / No. Street/PO Box, Suburb, Post Code
PHONE/FAX / PH: / FAX:
EMAIL
SECTION 2 – DETAILS OF POSITION BEING REQUESTED
SUB-SPECIALTY (if applicable) / GP with eg, Anaesthetics, Obstetrics or N/A (please circle)
NAME OF EMPLOYING BODY
PRIMARY FACILITY OF THE POSITION / NAME OF FACILITY:
ADDRESS: No. Street, Suburb, Post Code
SECONDARY FACILITY/IES OF THE POSITION
(if required, e.g aged care facilities, after hours services, public/private hospitals) / NAME OF FACILITY:
ADDRESS: No. Street, Suburb, Post Code
NAME OF FACILITY:
ADDRESS: No. Street, Suburb, Post Code
NAME OF FACILITY:
ADDRESS: No. Street, Suburb, Post Code
Note: Add more rows if required or a separate sheet.
LOCATIONS WHERE HOME
VISITS WILL BE REQUIRED
(e.g suburbs, towns, region etc) / Suburb-s, towns or N/A
SECTION 3 – OTHER INFORMATION
OTHER CURRENT IDENTICAL AREA OF NEED POSITIONS IN THE FACILITY (Please tick)
NONE YES - POSITION No./s _____ STATUS OF POSITION VACANT FILLED
Please note that applications are generally not approved when there is a vacant identical Area of Need position in the same facility.
What will be the impact on service delivery if the position is left unfilled?
Alternative strategies the employer has undertaken to fill the vacancy with a doctor holding specialist registration:
ADVERTISING
MAINSTREAM / HEALTH-RELATED
Name of Media: For eg, Seek, MyCareer, CareerOne, SMH, Australian
Date posted:
Date closed: / Name of Media: For eg, College website, RDN, Division of GP, NSW HealthJobs, Australian Doctor
Date posted:
Date closed:
Outcome of advertising:
Number of applicants who applied for the position: _____
Number of applicants interviewed: _____
Applicants interviewed were found unsuitable due to the following reasons (do not identify applicants by name):
SECTION 4 – CHECK LIST
NOTE: THESE ARE ALL NECESSARY COMPONENTS OF THE APPLICATION. IF ANY ITEM IS NOT CHECKED, PLEASE OBTAIN THE NECESSARY INFORMATION PRIOR TO SUBMITTING.
LABOUR MARKET TESTING / X
Copies of advertisements are attached.
Duration of advertising campaign is commensurate to RA classification of primary facility’s suburb (4 weeks for RA 1-2 or 2 weeks for RA 3-5)
Dates when the advertisements were posted and when they ended are clear on copies and are within 6 months from when the application is submitted.
Advertising content
·  shows position title, name of facility and location, required qualifications, skills, duties, salary, benefits
·  does not limit the pool of available applicants (ie does not refer to locums, overseas-trained doctors, female only etc)
·  includes the availability of incentive packages (i.e More Doctors for Outer Metro Program), if the primary facility’s suburb is within an Outer Metro area / or N/A
STAKEHOLDER CONSULTATION / X
Letters of consultation signed by the Chief Executive or delegated authority of the
·  relevant Local Health District
·  Royal Australian College of General Practitioners or the Australian College of Rural & Remote Medicine
·  relevant Division of General Practice
·  For those with secondary facility/ies, e.g other private hospitals, the management of the relevant facilities / or N/A
Letters of consultation detail:
·  Area of Need position title and primary facility
·  Advice on whether, in their opinion, there are insufficient GPs practising in that jurisdiction to provide services that meet the needs of people living that jurisdiction.
·  For those with secondary facility/ies, whether or not the stakeholder accepts the AON doctor’s services at the specified facilities / or N/A
Letters issued within 90 days from the date the application is submitted.
EVIDENCE OF NEED / X
District of Workforce Shortage confirmation or Preliminary Assessment of District of Workforce Shortage (PADWS)
·  is attached for all facility locations to be serviced by the position
·  is valid when the application is submitted
OTHER REQUIREMENTS / X
Position Description
·  is attached and it includes all locations/addresses
·  includes key selection criteria addressing clinical responsibilities
·  includes qualifications and experience required
·  includes the contact details for the position (Name, Phone, Email)
The position title and facilities are consistent on the application form, position description and letters of consultation.
SECTION 5 – APPLICANT’S DECLARATION
I confirm that I have completed the application form and check list and the details provided are correct.
SIGNATURE / DATE
The completed application form and check list, evidence of advertising, letters of consultation, District of Workforce Shortage classification (or Preliminary Assessment of District of Workforce Shortage) and position description should be sent to:

Attention: Area of Need Project Officer

NSW Ministry of Health

Workforce Strategy and Culture

Locked Mail Bag 961

NORTH SYDNEY NSW 2059

Email:

Fax: 02 9391 9019

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