CPCA Trainee Program Application

CPCA Trainee Program Application

Please ensure that you have answered all the required fields and uploaded all the required documents in order for your application to be submitted successfully.

APPLICANT'S DETAILS

PRIMARY CONTACT

The College uses the primary contact details for communication to applicants and members. Please make sure that the primary contact details are up to date.

WORK CONTACT

The College uses the work contact details in the FIND-A-DOCTOR section on CPCA's website if the applicant becomes a Fellow or Full Member. Please make sure that the work contact details are up to date.
Please include http:// or https:// in the website URL

IDENTITY DOCUMENTS

For documents that require to be certified, click HERE for certifying documents instructions.
Please upload your Curriculum Vitae (CV).
Accepted file types: jpg, gif, png, pdf, Max. file size: 5 MB.
Please upload a certified photographic copy of passport.
Accepted file types: jpg, gif, png, pdf, Max. file size: 5 MB.
Please upload a passport-quality head and shoulders photograph of yourself.
Accepted file types: jpg, gif, png, pdf, Max. file size: 5 MB.

APPLICANT'S EXTENSION DETAILS

APPLICANT'S INSURANCE DETAILS

DD slash MM slash YYYY
Please upload the current Certificate of Currency of medical insurance (including the category of procedures of cover, any loadings or restrictions and/or limitations)
Accepted file types: jpg, gif, png, pdf, Max. file size: 5 MB.

MEDICAL REGISTRATION

Please be specific. Indicate which body/organisation (e.g. TGA/HCCC/etc) imposed the restrictions or conditions and which are current, which are prior. Please include those that were dismissed or deemed not necessary to appear on any registers, etc. (max. 3 lines)
Please upload a certified copy of AHPRA registration certificate.
Accepted file types: jpg, gif, png, pdf, Max. file size: 5 MB.

UNIVERSITY OF GRADUATION

Accepted file types: jpg, gif, png, pdf, Max. file size: 5 MB.

FURTHER TRAINING & EDUCATION

Please provide information of further training and education undertaken in the field of cosmetic medicine. If insufficient space, please upload extra page/s in place provided.
Drop files here or
Accepted file types: jpg, gif, png, pdf, Max. file size: 5 MB.

    MEMBERSHIPS & REFERENCES


    Memberships
    (Please include the telephone number of the entity)
    (Please include the telephone number of the entity)
    (Please include the telephone number of the entity)
    (Please include the telephone number of the entity)
    Drop files here or
    Accepted file types: jpg, gif, png, pdf, Max. file size: 5 MB.
      References
      Please provide name and contact details of three (3) referees, who should be registered medical practitioners, preferably from those who currently are practising cosmetic medical procedures. Wherever possible, you should choose those medical practitioners who have an interest or willingness to assist with mentorship.
      Where contact details could not be provided.
      Drop files here or
      Accepted file types: jpg, gif, png, pdf, Max. file size: 5 MB.

        COSMETIC PROCEDURES OR SERVICES CURRENTLY PERFORMED/PROVIDED


        Please proceed to the following table to indicate which cosmetic procedures and services you are CURRENTLY performing and to what degree of competency.

        On a scale of 1 to 10, with 10 being extremely competent and 1 being new to this procedure, please mark accordingly.
        As a guide:
        0 = Never performed.
        1 = Done a few, feeling my way.
        5 = Done several with my technique improving.
        8 = Solid, competent and confident to manage complications.
        10 = Expert with years of experience and other colleagues seek my advice.
        Write description here and put your grading in the next available field.
        Write description here and put your grading in the next available field.

        OTHER COSMETIC MEDICAL ACHIEVEMENTS AND/OR SERVICES PROVIDED


        Publications
        Please advise the name of the publication, the topic of the article and the date published.
        Teaching/s
        Please provide a short description.
        Presentations
        Please provide a short description.
        Mentoring
        Please provide a short description.

        Please ensure that you have answered all the required fields and uploaded all the required documents before clicking the "Submit" button.