TEMPORARY RETURN OF HEALTH PROFESSIONALS TO ZIMBABWE

PRE-APPLICATION FORM
Title
Name
Date of birth (dd/mm/yyyy)
Nationality
Current Address
Telephone (include country code)
Email address
Profession
Specify
Years of working experience
Do you have a current professional registration certificate to work/practice in Zimbabwe
Please specify

Please give details of your degrees/diplomas/certificates, field of study, institutions attended, and date of graduation.

 
Qualification*
Field of Study*
University College*
Location*
Year of gratuation*
 
Qualification
Field of Study
University College
Location
Year of gratuation
 
Qualification
Field of Study
University College
Location
Year of gratuation

Please indicate how you would like to contribute to health services in Zimbabwe

 
PREFFERED CONTRIBUTION
If you are able to donate equipment or
materials specify types and quantities
For how long would you be able to provide services in Zimbabwe?
Other (specify)
How soon would you be available to take up the placement?
Other (specify)

May you indicate the month and dates of availability

 
Month
Date
Would you like to contribute to emergency response in Zimbabwe?
If your response is 'yes' explain how youwish to contribute?
Would you be able to organize a team of health professionals to conduct joint medical procedures or provide servicesin Zimbabwe
   
If 'yes' provide details (e.g. possible teamcomposition, number and what procedures)
   
Would you be willing to work as part of a team of health professionals?
   
Are you a former lecturer in Zimbabwe?
   
If 'yes' provide details of institution,courses and periods:
   
Would you prefer to work in a particular province in Zimbabwe?
   
If 'yes' provide name and preferredprovince

 

NB: All personal information provided in this application form will be treated as confidential and will not be shared with any third partyor unauthorised person without your consent.

Thank you for expressing interest in the Temporary Return Health Professionals to Zimbabwe programme. Please foward this form by clicking on the "Submit by Form " button.