Request a Locum

Practice name*

Name of requestor*

Email*

Contact number*

Name of GP/RN PN for replacement*

On call ratio

FTE

MCNZ/NZN0 number*

Type of position required*

Short term is less than 3 months.

Number of sessions/hours*

Days of work*

On call requirements*

(short term locums do not do on call duties)

Remuneration

Remuneration (Permanent Only)

Short Term Placement Per Session

Relocation assistance (travel costs/removals)*

Will the locum GP/PN RN be engaged as an employee or contractor?*

Vehicle assistance (provided/subsidised by practice)*

Accommodation assistance (provided/subsidised by practice)*

Other assistance (eg MCNZ/NZNo registration, medical indemnity insurance, other by practice)*

Desired personality of the doctor (think of a GP/RN who is working well in the practice and describe their qualities)

What makes your practice an ideal place to work?

What characteristics of the practice will the GP/RN PN need to be made aware of?

Any other relevant information/comments?

Who will provide supervision (if required)?*

Supervisor 1 Supervisor 2

From (first day in practice)

To (last day in practice)

Number of sessions required (days/week)*

Other comments

We cannot guarantee to you to be able to provide a locum for these date(s).

If you have any questions please call 09 407 3581 or email us at locumgpinfo@tttpho.co.nz

Does the practice hold a PRIME contract?*

Will the locum be required to attend PRIME callouts?*

What patient management system does the practice use?*

Other patient management system details*

Comments

This field is for validation purposes and should be left unchanged.