GP Locum Vacancy Form

Host Health Service

Clinic Location

First Name

Last Name

Phone Number

Position Title

Cover Type

If Leave, name of Dr. to be covered

Placement Start Date

Placement End Date

Daily Rate ($)

If public holidays included, do you require the locum to work them?

Accommodation arranged by

Other information (e.g. locum name (if already identified))

​GP Locum Vacancy Form