Your First Name (required)
Your Last Name (required)
Your Email (required) *
Your Postal Address*
---select---Specialist AnaesthetistSpecialist SurgeonObstetrician/GynaecologistSpecialist PhysicianPaediatricianOncologistPathologistGeneral PractitionerNon-specialist DoctorDoctor in trainingMedical StudentRegistered NurseEnrolled NurseAssistant in NursingPhysiotherapistOccupational TherapistDentistOther
Have you in the past ever had your professional registration suspended, cancelled, or restricted? *
Have you in the past ever been the subject of a disciplinary hearing with the Health Care Complaints Commission (HCCC) or the Medical or Nurse Council or other Professional Governing Body? *
Have you ever been convicted of a criminal offence? *
Have you ever been convicted of a child sex offence? *
If you have answered "yes" to any of the above, please explain.
if you are an Australian Health Professional, do you have current full registration with AHPRA for your qualification? *
If you are a doctor, do you have current medical indemnity protection to practice your qualification (this only applies to doctors so select "not applicable" if you are not a doctor)? *
Do you agree to notify DAISI within 7 days of being convicted of a criminal or child sex offence? *
Do you agree to notify DAISI within 7 days of having any conditions, suspension or cancellation imposed on your registration? *
Do you have a current Working With Children Check (WWCC) certificate? *
If you have a WWCC certificate please enter the registration number and issue date.
Do you have a current National Police Certificate (NPC)?*
If you have a current National Police Certificate (NPC) please enter the certificate number and issue date below:
If you have answered "No" or "Not Applicable" to any of the above, please explain.
Agreement to abide by DAISI's Code of Conduct
As a member, I agree to abide by DAISI’s Code of Conduct which requires me to: 1.Uphold the highest standards of honesty and integrity in the conduct of duties;2.Respect the dignity of the public, our beneficiaries, other volunteers & DAISI members, and other employees & partners by treating them with courtesy, honesty and sensitivity to their rights; 3.Treat others in the workplace fairly and with respect;4.Exercise the best judgment in the interests of DAISI and its members, volunteers, partners, and beneficiaries; 5.Make decisions ethically, fairly and without bias using the best factual information available; 6.Comply with any legislative, industrial or administrative requirements, and all lawful and reasonable directions given by persons in authority; 7.Comply with all DAISI’s policies and procedures; 8.Act responsibly in the event of becoming aware of any unethical behaviour or wrongdoing by any other employee or volunteer and report such conduct or activities to the appropriate level of management; 9.Protect those most vulnerable reporting any actual or suspected child abuse, sexual exploitation, workplace bullying sexual harassment, or discrimination based on gender, race, or religion; 10. Maintain confidentiality with all information obtained or developed in the course of the conduct of DAISI’s business and which if disclosed will or could lead to risk, damage or injury to DAISI, its Directors, Office Bearers, Members, Employees, Volunteers, Beneficiaries, Contractors or third parties; 11. Agree to avoid any conflict of interest, and to maintain clear professional boundaries with partners & beneficiaries in the South-Pacific & 12. Not solicit or accept any gifts, benefits or additional money for myself during dealings with DAISI (other than salaried employees) or gain unfair workplace or business advantage as a result of my membership with DAISI.
I confirm that the above-entered information is accurate, and that I agree to abide by the above DAISI Code of Conduct.
DAISI is a registered charity with the Australian Charities and Not for-profits Commission (ACNC)
DAISI is committed to adhering to the Australian Council For International Development (ACFID) Code of Conduct.
Doctors Assisting In South Pacific Islands Pty Ltd (DAISI)
PO Box 679, Crows Nest, NSW 1585.
shop 1, 38 Pacific Hwy, St Leonard’s NSW 2065
© DAISI 2015 ABN 72 642 539 080