Medical Staff Registration Form

Are you a Doctor, Nurse or Paramedic? Then Azura Medica is looking for you. We have a number of medical staffing positions available for exciting projects in Asia. Leave your details below and our Medical Management Team will reach out to you when you match the requirements of one of our projects. All information will be treated in strict confidence and for project recruitment-related purposes only. Alternatively, feel free to email recruitment@azuramedica.com if you want further information. We look forward to hearing from you. Azura Medica Medical Management Team

Contact Details

Name *

First

Last

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Email *

Phone

Personal Details

Citizenship (country) *

Current Passport Expiry Date *

Professional Qualifications

Type of Medical Qualification *

University *

Date of graduation *

Other relevant university degrees (not certificates)

Please upload a copy of your Degree of Diploma Documents & your Current Registration Certificate *

Click or drag files to this area to upload. You can upload up to 5 files.

PDF FIles Only (Max 100 MB per file)

Professional Certificates

Please upload copies of your valid certifications *

Click or drag files to this area to upload. You can upload up to 10 files.

PDF FIles Only (Max 100 MB per file)

Work Experience: include 3 relevant projects and employers that you worked for in the last 10 years

Project 1: Company Name *

Project 1: Location *

Project 1: Job Title *

Project 1: Type of Project *

Project 1: Start Date of Employment *

Project 1: End Date of Employment *

Project 2: Company Name *

Project 2: Location *

Project 2: Job Title *

Project 2: Type of Project *

Project 2: Start Date of Employment *

Project 2: End Date of Employment *

Project 3: Company Name *

Project 2: Location *

Project 2: Job Title *

Project 3: Type of Project *

Project 3: Start Date of Employment *

Project 3: End Date of Employment *

Upload CV

Please upload your resume *

Click or drag a file to this area to upload.

PDF FIles Only (Max 100 MB per file)

When can you start? *

Feel free to ask us any questions, provide feedback or simply tell us something unique about yourself!

Name

Contact Details

Personal Details

Professional Qualifications

Professional Certificates

Work Experience: include 3 relevant projects and employers that you worked for in the last 10 years

Upload CV

Event Location

Risk Assessment

Medical Capabilities

Hospitals

Emergency Transport Options

Notification Procedures

Maps of event location

Other details

Kindly leave your contact details here:

Your Contact Details