Practising Expert/Specialist Next Steps: Install a Payment Add-OnTo accept donations on this form you will need to install one of our payment add-ons. To learn more about your payment add-on options, visit the following page (https://www.gravityforms.com/blog/payment-add-ons). Important: Delete this tip before you publish the form.Name* First Name Surname ID NumberDOBGenderMaleFemaleDrivers Licence No.Physical AddressProfessionQualificationsCurrent Employer/Institution of AffiliationCurrent PositionProfessional Charge Rate ($/unit)Years of experienceIndicate Professional Pledge Per month/year Contactable Referees1.2.AvailabilitySTP (1 week-3 months)AHA (once off assignments-hours/days)ERS (Hours/Days as required)DRM (Hours/Days, as required)Have you been convicted of any crime, other than traffic offences & maintenance related?YesNoGive Date of conviction Date Format: MM slash DD slash YYYY OffenceKey to AvailabilitySTP (1 week-3 months)-Short Term Placements MTP (3-12 months)-Medium Term Placements ERS (Hours/Days as required)-Emergence & Relief Services DRM (Hours/Days, as required)- Domestic Repair and Maintenance Works AHA (once off assignments-hours/days)-Ad Hoc Assignments Total $0.00
