Application Form / CV :Surgeon MSF

PERSONAL DETAILS

First name:

Family name:

Postal address:

Email address:

Phone number: Mobile phone:

QUALIFICATIONS

Primary Qualification:

Date obtained:

University, City, Country:

Specialist Qualification:

Date obtained:

University, City, Country:

Medical registration/licence number:

SUMMARY of EMPLOYMENT HISTORY Please complete with most recent post first and give only a brief description of your role

Dates (start and finish)

/

Job Title

/

Location

CURRENT EMPLOYMENT Please give details of your current or most recent post

Post:

Hospital:

Dates:

Summary: [Include duties & responsibilities and clinical skills you use. EG for orthopaedic surgery: internal/external fixation, plastics, joint, infected post-trauma, burns. EG for general surgery: paediatrics, trauma, burns, C-section. Also refer to examples in table below]

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Obstetrics: Do you have experience doing C - section surgery?

Y N. If YES, approximately how many have you done?......

NB/ General surgeon applicants must have performed at least 8 C-sections in the past 2 years

CLINICAL SKILLS, TECHNIQUES and EXPERIENCE

Please write NIL if you have no experience in a particular area. Insert additionalrows as required

Clinical skill, technique or type of experience / Exact type of procedure / Number per year (last 5 yrs) / Earlier experience (no. per year) / Years of experience
General Surgery
Ortho / trauma experience (conservative /open fracture)
ChronicOsteomyelitis
Emergency room /Triage
Obstetric experience ( include details of C - section )
Hospital management /teaching/team leading

EXAMPLES OF POSSIBLE EXPERIENCE

Breast surgery – Biopsy & excision of fibro adenomas, mastectomy
Gallbladder, liver and pancreas - Cholecystectomy. liver biopsy, liver resection, trauma liver; packing of the liver
Esophagus and stomach, small bowel, spleen – Esophageal, gastric resection / gastric bypass,
splenectomy, partial splenectomy, small bowel resection & anastomosis, appendectomy etc
Colon, Rectum and anus – right and left hemicolectomy / anterior resection, Hartmann’s procedure
sphincterotomy / hemorrhoidectomy, colostomy / closure of colostomy
Urology – Suprapubiccystostomy open/ closed; repair of bladder / nephrectomy
Trauma – Tube thoracostomy / thoracotomy, laparotomy, repair of blood vessel injury of neck, chest & abdomen, trachea and esophagus, application of cervical collar & immobilization of patient with spinal cord injury
Others – Hernia repairs of elective/strangulated hernias, adhesiolysis in partial & complete obstruction of bowel
Subspecialties
Pediatric Surgery - hydrocoele repair, repair of inguinal hernia incarcerated or strangulated, colostomy for Hirschsprungs, appendectomy
Burns - Resuscitation burns, debridement burns, skin grafting of burns
Obstetrics and Gynecology - Cesarean section, hysterectomy, repair of ruptured uterus, PPHEctopic pregnancy, repair of vaginal & perineal tears, repair of vesico-vaginal fistulas
Othopedics – Fracture management (conservative POP), internal fixation, finger and toe amputation, Syme’s Amputation, above/ below the knee amputation
Other Skills - Cardio-Pulmonary Resuscitation (CRP), sesuscitation trauma victims – ATLS, Ultrasound

OVERSEAS APPOINTMENTS HELD / FELLOWSHIP TRAINING

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AVAILABILITY

Available from:

Available for how long:

Amount of notice required:

Type of context preferred:

LANGUAGES

FLUENT
(ECTS C1-C2)
I can understand complex speech and texts, and express myself without much hesitation / GOOD
(ECTS B1-B2)
I can understand most of what I hear and read, and can express myself effectively on general topics / FAIR
(ECTS A2)
I can understand common words and phrases and can express myself in short, simple sentences
English
French + +
Other (specify)

++ Applicants with French language skills may be requested to undertake an assessment

REFEREES(at least 3 colleagues able to provide information on your personal and professional skills. Referees will not be contacted without applicant permission)

Name: / Name:
Title/position: / Title/position:
Postal address: / Postal address:
Email: / Email:
Phone: / Phone:
Name: / Name:
Title/position: / Title/position:
Postal address: / Postal address:
Email: / Email:
Phone: / Phone:

Privacy declaration: I agree to Médecins Sans Frontières (MSF) collecting relevant information (eg, work references, police reports) about me in relation to my application for field work for MSF, including information regarding my performance in the field should I be successful in my application. The information collected will only be used for MSF purposes in accordance with MSF Australia’s Privacy Policy. A copy of our Privacy Policy is available on request and on our web site:

Médecins Sans Frontières has a Child Protection Policy in place and all employees are required to comply. A copy of the policy is available on request and on our web site:

Signature: ……………………………………………………. Date:……………………..

Please email (preferred method) your completed application form/CV AND your letter of motivation to:

r sendto: Field HR Recruitment, MSFAustralia, PO Box 847, Broadway NSW 2007 Australia.