Pre-employment structured clinical interview (PESCI) application Form

This application form is for International Medical Graduates (IMG)who intend to apply to AHPRA for special purpose registration via the Competent Authority Pathway or Standard Pathway to work in a General Practitioner position, and who wish to undertake a Pre-employment Structured Clinical Interview (PESCI)with HWAV.

To be eligible to apply the applicant must have passed the Australian Medical Councils (AMC) multiple choice question examination or be eligible for provisional or limited registration.Medical Board Australia

Please use the checklist below to ensure that the following documents are submitted with this application form:

Comprehensive Curriculum Vitae (CV) using HWAV Curriculum Vitae Template

Position Descriptiontemplate for the position for which registration is being sought

MBA/AHPRA Supervised Practice PlanTemplate and Supervisors agreement (SPPA-30)

RACGPoverseas General Practice experience assessment certificate.
Please note; If applying for limited registration and you do not have a minimum of 3 years full time equivalent overseas General Practice experience, as assessed by RACGP or AHPRA, you may not be eligible to sit the PESCI. This rule does not apply to applicants applying for provisional registration.

A copy of your passport (the original will be required to be presented at the interview)

Consent Form

Payment Form

Primary medical qualifications verification WDOMS service and AMC
IMGs applying for limited registration or provisional registration must provide evidence of being awarded a primary qualification in medicine and surgery by a training institution recognised by both the Australian Medical Council and the World Directory of Medical Schools (WDOMS).
Primary source verification
More information about the primary source verification process is available on the AMC website.
IMGs are eligible for provisional registration via the Competent Authority pathway if they have met the defined requirements for a competent authority country.
More information on the competent authority pathway is available on the Board’s website.

PESCI application documentation is sent to the Medical Board with the PESCI outcome report.

Please complete all sections of this form as accurately as possible. Incomplete documentation will be returned to the applicant. HWAV may seek verification of the information in this form at its discretion without notice to the applicant.

NB: Applicants should be ready to undertake their interview within 4-8 weeks of submitting their application.

Should you require any assistance to complete your application, you may contact our Assessment Administrator on (03) 9347 7813 or email at .

Section One – Application Details

PERSONAL DETAILS
Surname: / First Name: / Middle Name:
Gender: M/F / Date of Birth (dd/mm/yyyy):
Postal Address: / Work Address:
Email:
Mobile Number: / Home Number: / Work Number:
PROPOSED EMPLOYMENT DETAILS
Name of practice: / Proposed position:
Supervisor: / Supervisor Email:
Practice Manager* / Practice Manager Email:
Postal Address: / Work Address:
Tel. Number: / Fax Number: / Email:
REGISTRATION TYPE BEING SOUGHT
a)Limited registration (Area of Need),
b)Limited registration (Postgraduate training or supervised practice) or
c)Provisional registration
d)If you currently hold medical registration
please provide your registration number
PREVIOUS PRE-EMPLOYMENT STRUCTURED CLINICAL INTERVIEW (PESCI)
Have you previously undertaken a PESCI: / Yes
No
If Yes, through which organisation:
Date of previous PESCI:
I would like to have a PESCI in the week commencing:

* Alternatively,please supply details of an administrative contact at the practice who has knowledge of the position offered.

Section Two - Eligibility

ELIGIBILITY
I ______declare that:
[ENTER FULL NAME]
  • afteranapprovedcourseofstudy,Ihavebeenawardedaprimarydegreein medicineandsurgerybyamedicalschoollistedin WDOMS and approved by the AMC.
  • (choose one option below):
English language requirement
I have met the English language proficiency requirements with an IELTS grade of 7.0+ across all categories, or equivalent as outlined in the policy which appears on the Medical Board of Australia’s website; or
I havenot met the English language proficiency requirements as outlined in the policy which appears on the Medical Board of Australia’s website; and I am aware this is a requirement to apply for registration.
  • (choose one option below):
Limited Registration
I have passedtheMultipleChoiceQuestionExaminationoftheAustralianMedical Council; and
  • I understand that to be eligible to sit for a Pre-Employment Structured Clinical Interview (PESCI) under limited registration, I must have a valid offer of employment that has certification for Area of Need or District Workforce Shortage or have been granted a valid exemption from the Department of Health for the relevant state.
Provisional Registration
I have passed the MultipleChoiceQuestionExaminationand Clinical Examination of the Australian Medical Council; or
I have been awarded a Certificate of Advanced Standing by the Australian Medical Council prior to 1 July 2014; or
I am eligible for assessment as part of the Competent Authority Pathway for provisional registration.
  • I understand that to be eligible to sit for a Pre-Employment Structured Clinical Interview (PESCI) under provisional registration I must have a valid offer of employment.
  • Iunderstandthat thePESCIOutcomeReportwrittenbyHWAVwill be sent totheMedicalBoardofAustralia in the relevant state/territoryandthatthereportwillbeonly oneofarangeoffactorstakenintoconsiderationbytheBoardwhenmakinga determinationinrespecttomyapplicationforregistrationto practiseintheproposedposition.
Signature: ______Date ______/______/_____

Section Three – Assessment Criteria

In no more than 200 words per criterion please outline how you meet each of the following assessment criteria.
Clinical competence in medical knowledge required for the position for which employment is being sought.
Clinical skills required for the position for which you are seeking employment.
Ethics and professional attitudes for safe and effective clinical practice.
Communication skills required in the position for which employment is being sought
Awareness of Australian social and culturalissues

Section Four – Privacy

DECLARATION
  • I declare that the information I have provided on this application form and its attachments is complete and correct.
  • I agree that HWAV may seek to verify information without first notifying me.
  • I am aware the interview outcome report will be sent to MBA.
  • I understand that the PESCI is only one of a range of factors taken into consideration by MBA when determining an application for registration.
  • I understand a cancellation policy applies. Details of the policy can be found at
Signature: ______Date ______/______/_____

Submitting your application:

Please forward your completed application form with all supporting documentation and payment to:

Email:

Fax: +61 3 9349 7813

Mail: PESCI Interview Application

HWAV

Level 6, Tower 4 WTC

18-38 Siddeley Street

Melbourne Victoria 3005

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