Online Locum Form

We have practices that also request cover for their daytime practice, please indicate what type of work you would prefer to work: *

If yes to Out of Hours

NEDOC requires the name of 2 referees of doctors with whom you have worked in Ireland and their details. If you have not previously worked in Ireland please provide the name, phone number and email of two doctors with whom you have worked. Please ensure your nominated referee is aware that we will require a reference

Referee 1

Referee 2

• MCR
• Medical Indemnity
• CV
• Copy drivers licence / passport
• Two GP References from GPs with whom you have worked
• Copy of Garda Vetting or Police Clearance certificate
• Details of any sanctions received from a Medical Regulatory Authority (Medical Council / General Medical Council / other)