Confidential Application for Medical


Please read the following Privacy Statement before filling out your application.

Alive Clinics Pty Ltd Privacy Statement

Alive Clinics Pty Ltd and its subsidiary companies is fully committed to meeting the requirements of the Privacy Act 1988 (Cth) and the Health Records Act 2001. The personal information collected on this application form will be used to assess the suitability of the applicant for the position advertised and to negotiate with and make offers of employment to selected applicants. Further, for successful applicants, the information will be used for the supervision, management and payments of employees, to develop and maintain the employment relationship between the employer and the individual.

Fields marked with (*) on the application form are regarded as mandatory for selection purposes. Failure to provide these data may influence the processing and outcome of your application. However, for successful applicants, the information supplied in the application form may be passed onto our insurers, bankers, any relevant staff union and superannuation fund managers. It is the policy Alive Clinics Pty Ltd to retain the personal information of unsuccessful applicants for future recruitment purposes for a period of 6 months.

Under the Privacy Act 1988 (Cth), applicants have the right to request access to, and to request correction of their personal information collected in this form. If you wish to exercise these rights, please contact the Privacy Officer in your State. Alive Clinics Pty Ltd and its subsidiary companies will not disclose such health information of applicants to a third party without first obtaining the applicant’s consent unless the disclosure is required by law or by statutory authorities.

Personal Details

Experience: Experienced Cosmetic Doctor
GP (with interest in skin cancer or cosmetic surgery)
Plastic Surgeon
Experienced Skin Cancer Doctor
If other, please specify:
Employment Type:

Preferred Location:
*Full Name:
*Home Phone:
*Work Phone:
*Date of Birth:

Next of Kin in Case of Emergency


Health History

*Do you have currently or have you had any health problems which may interfere with the performance of the position applied for?
*If yes, please specify:

Current Skills

Current skills in cosmetic medicine:
Current skills in skin cancer medicine:
Current skills in womens health, hormone therapy, nutrition or anti aging:


Long term career goals:
Treatments you wish to perform:


Date available to start:
Days and Times Available:


How long are you willing to commit?

Start Date:
Finish Date:

Personal History

*Have you ever worked for the company before?
If yes, state details and reasons for leaving:
A criminal record will not necessarily preclude you from employment, but full disclosure is required.
*Have you ever been convicted of a criminal offence?
*If yes, give details:
Have you any relatives in our employ?
If yes, state details:
Are you currently employed, attending training, university or college?
Do you have current professional indemnity insurance?
(You will need to supply documentation upon job placement.)


College Memberships or Fellowships Name of School College or University Location Year

Previous Practicing History

Company Name Phone No. or Address Date From Date To Reason for Leaving
*Work Reference Contacts:  
Name 1:
Company 1:
Phone 1:
Name 2:
Company 2:
Phone 2:
Current Position:
How many patients do you currently see per hour?
How many patients do you wish to see per hour?
Reason for applying for the position:
Why do you think you should be considered?
Do you want shift work?
How much do you wish to earn per week?
Computer Skills: Word
Medical Director
If other, please specify:
Any hobbies?


I have checked that all questions have been answered in full and when signing this application I understand the following:

  1. This is not a contract of employment.
  2. This application will be passed on to an Alive Clinic franchise in your preferred area.
  3. I am able to notify the company of any change of address or changes to my application.

In submitting this application for job placement I understand that misrepresentation of facts is sufficient cause for termination of any contract that is entered into with an Alive franchise.


 I have read and accept the above terms