1. society
2. welfare
3. healthcare
4. hospital

SHPA 2016 Vic Internship - Application
1. SHPA Vic Branch - Victorian Hospital Intern Application 2016
Thank you for your interest in applying for a hospital internship in a Victorian public hospital for 2016.
Use this online tool to complete your application.
Important points:
- Have all of your information ready prior to commencing the survey.
- You ARE NOT able to save and return to the survey at a later time.
- You can only complete the survey once.
- Use your official university email address only. Other email addresses will not be accepted for
application.
- Your details will be forwarded to your first preference hospital initially. Your details may be forwarded to
other hospitals if required to complete the intern allocation.
1/9
11%
Next
1
SHPA 2016 Vic Internship - Application
2. Applicant Details
* Contact Details
Note: ONLY use your university email address for correspondence
Given Name(s)
Surname
Preferred Name
Semester address
Suburb
State
Postcode
Email address
Phone number
Holiday Address (if different from above)
Address
Address 2
City/Town
State/Province
ZIP/Postal Code
Country
Phone Number
Date of Birth
DD
Date
MM
/
YYYY
/
2
* At which University are you completing your Pharmacy degree?
Monash University
RMIT University
La Trobe University
Other (please specify degree and institution)
* Enter your student number
* Are you a citizen or permanent resident of Australia?
Yes
No
2/9
22%
Prev
Next
3
SHPA 2016 Vic Internship - Application
3. Applicant Details
This information will be sent to hospitals to assist them in deciding upon candidates.
Keep the information generic and express why you feel you would be a good candidate for a hospital
internship.
* Provide a candidate's statement for hospitals to read.
Enter your text into the box below.
You should introduce yourself and detail why you would be a good candidate for a hospital
internship.
Referees
Please provide up to three referees.
Ensure you have their consent to be contacted by hospitals.
Referee #1
Name
Position
Organisation
Contact details
4
Referee #2
Name
Position
Organisation
Contact details
Referee #3
Name
Position
Organisation
Contact details
What is your Grade Point Average (GPA) for yourpharmacy degree to date?
Do not include GPA results from other degrees.
For La Trobe University students:
La Trobe University provides Grade Summaries in Weighted Average Mark (WAM) rather than GPA. Please use the below
calculator to provide an approximation:
3/9
33%
Prev
Next
5
SHPA 2016 Vic Internship - Application
4. Other Supporting Information
Use this page to add additional information for you application.
Pharmacy Employment History
Previous Hospital Placements & SHPA Summer placements
(Include dates and location)
6
Other Employment History
Other Skills and Attributes
4/9
44%
Prev
Next
7
SHPA 2016 Vic Internship - Application
5. Other Education
Add details of other educational achievements here.
Do not include your pharmacy qualification in this section
Other education
5/9
56%
Prev
Next
8
SHPA 2016 Vic Internship - Application
6. Hospital Ranking
Please rank the hospitals you wish to apply to in your preferred order.
You can drag and drop the hospitals into your preferred ranking.
If you do not wish to work at a specific hospital then tick the checkbox to the right.
Please note: if you rank a hospital you may receive an offer to work at this hospital.
9
* Hospital ranking
Albury Wodonga Health Service
I do not wish to apply at this hospital
Alfred Health
I do not wish to apply at this hospital
Austin Health
I do not wish to apply at this hospital
Ballarat Health Services
I do not wish to apply at this hospital
Barwon Health
I do not wish to apply at this hospital
Bendigo Health
I do not wish to apply at this hospital
Central Gippsland Health Service
I do not wish to apply at this hospital
Eastern Health
I do not wish to apply at this hospital
Echuca Regional Health
I do not wish to apply at this hospital
Latrobe Regional Hospital
I do not wish to apply at this hospital
Mercy Health
I do not wish to apply at this hospital
Mildura Base Hospital
I do not wish to apply at this hospital
Monash Health
I do not wish to apply at this hospital
Northern Health
I do not wish to apply at this hospital
Peninsula Health
I do not wish to apply at this hospital
Peter Mac Callum Cancer Centre
I do not wish to apply at this hospital
Royal Children's Hospital
I do not wish to apply at this hospital
Royal Melbourne Hospital
I do not wish to apply at this hospital
Royal Women's Hospital
I do not wish to apply at this hospital
St Vincent's Hospital
I do not wish to apply at this hospital
Western Health
I do not wish to apply at this hospital
Wimmera Health Care Group
I do not wish to apply at this hospital
6/9
67%
Prev
Next
10
SHPA 2016 Vic Internship - Application
7. Availability for Interviews
Do you know of any dates e.g. examinations, placements or other events, which may impact on
your availability for interviews? If yes, please give details, otherwise leave this response box
blank.
7/9
78%
Prev
Next
11
SHPA 2016 Vic Internship - Application
8. Security number confirmation
Please enter a four digit number that you can use in the event that you wish to change your preferences.
Write it down and store it safely.
Please note that this number will not be encrypted by the SHPA, so avoid using a sensitive number like
your bank card PIN.
Keep this number secret. If you choose to change your preferences later, we will ask you for it. This is so
that nobody else can log in and claim to be you, and change your preferences.
Choose a security number
8/9
89%
Prev
Next
12
SHPA 2016 Vic Internship - Application
9. Application finalisation
Please review your responses. Once you have submitted your application you will not be able to edit it.
* Please read carefully:
All the information I have provided is true to the best of my knowledge
I allow SHPA to store my application details and forward it to hospitals in my preference list
for the purposes of applying for a Victorian Public Hospital Pharmacy Internship in 2016
I have only ranked hospitals at which I have in interest in undertaking an internship
I allow SHPA to contact my University to verify my enrolment and eligibility
I allow SHPA to forward my application to my top ranked hospital
I allow SHPA to forward my application to more than one hospital in my preference list
should these vacancies require filling
I have not completed this application more than once
I am to the best of knowledge eligible to graduate from an approved Pharmacy qualification
by 2016
I understand that giving false or misleading information may result in my application being
cancelled by the SHPA
I understand these terms and wish to apply
I consent to SHPA providing me with information regarding membership and educational activities
I accept
9/9
100%
Prev
Done
13