REQUEST FOR TRANSFER TO ANOTHER INSTITUTION WITHIN
VICTORIAN ANATOMICAL PATHOLOGY TRAINING PROGRAM 2016
DO NOT CHANGE ANY PART OF THIS FORM. FILL IN THE SPACE IN THE BOXES PROVIDED
Surname
First Name
Postal Address (including postcode)
Home Phone Number
Mobile Phone Number
Email address
Year of commencing Anatomical Pathology Training
Current Appointment
Previous appointments in Pathology and number of months acknowledged by RCPA for
each position (include exam successes if any)
To complete with supervisor:
1. Are there areas in your training that you and your supervisor believe you are currently
deficient in, and 2. Will the current appointment assist this (Supervisor to sign):
SUPERVISOR’S NAME AND SIGNATURE
NAME
SIGNATURE
DATE
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I DO NOT wish to transfer (tick)
Please sign declaration at end of document.
NO further parts of this document need be
completed.
I DO wish to transfer (tick)
Please continue.
Reason for requesting transfer
Comments for consideration including reasons why certain laboratories are NOT preferred.
Referees
Name, full address, contact numbers, email address and fax number of two referees (must be
consultants and Referee 1 must be your current supervisor) with whom you currently work:
Referee No 1 (Must be current Supervisor)
Surname
First Name
Work Phone Number
Mobile Phone Number
Fax Number
Email Address
Referee No 2
Surname
First Name
Work Phone Number
Mobile Phone Number
Fax Number
Email Address
Current Appointment
Current Appointment
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APPLICANT’S PREFERENCES
Please number ALL institutions, in order of your preference (please note that many of these appointments will
include rotations to other laboratories – for details, discuss with relevant Heads of Department). Registrars who
do not complete the form do so at their own risk.
Please note: As this is a matching process it is in your interest to contact these laboratories and take part in
their own recruitment process as they remain the employing authorities.
The Alfred Hospital
Austin Health
Cabrini Health, Cabrini Hospital Pathology
Dorevitch Pathology, Albury
Dorevitch Pathology Ballarat Hospital
Dorevitch Pathology Frankston Hospital
Dorevitch-Gippsland Pathology, Latrobe Regional Hospital, Traralgon
Dorevitch Pathology, Heidelberg
Dorevitch Pathology, Western Hospital
Eastern Health Pathology, Box Hill Hospital
Healthscope Pathology, Bendigo Base Hospital
Healthscope Pathology, Clayton
Healthscope Pathology, Northern Hospital
Melbourne Pathology, Collingwood
Melbourne Health Shared Pathology Service, Royal Melbourne Hospital
Southern Cross Pathology Australia, Monash Medical Centre
Peter MacCallum Cancer Centre
Royal Women’s Hospital and Royal Children’s Hospital
St John of God Pathology, Ballarat
St John of God Pathology / PathCare Geelong
St Vincent’s Hospital
Victorian Institute of Forensic Medicine
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PROCEDURES TO BE FOLLOWED BY APPLICANT
CHECKLIST – SUBMISSION of DOCUMENTS
1. Application form
Only if transfer is requested, then also include
2. Curriculum Vitae
3. Referee Reports (document VAPTP-2F)
4. Most recent Competency Form (VAPTP-5B)
Please submit applications electronically ONLY to:
Aleen Nazaretian
Administrative Assistant, Victorian Anatomical Pathology Training Program
The Royal College of Pathologists of Australasia
Email: aleen.nazaretian@rcpa.edu.au
Applications close 31 July 2015
APPLICANTS ARE REMINDED THAT THEY WILL NOT BE CONSIDERED FOR TRANSFER WITHIN THE
TRAINING PROGRAM IF THEY FAIL TO STRICTLY ADHERE TO THE ABOVE PROCEDURES.
PLEASE NUMBER ALL INSTITUTIONS
YOU WILL BE NOTIFIED WHEN BOTH REFEREE REPORTS ARE RECEIVED
BUT IT IS YOUR RESPONSIBILITY TO ENSURE ALL RELEVANT DOCUMENTATION HAS BEEN SENT.
THE VICTORIAN ANATOMICAL PATHOLOGY TRAINING PROGRAM ACCEPTS NO RESPONSIBILITY
FOR INCOMPLETE DOCUMENTATION RECEIVED.
The Match will most likely be held during September 2015. You will be notified of the result. If you have any
queries concerning the transfer process contact Aleen Nazaretian on aleen.nazaretian@rcpa.edu.au
APPLICANT’S DECLARATION
If appointed I agree to observe all hospital by-laws, regulations and rules.
NAME
DATE
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