OTP Eligibility Check Application (Phase 1)

OTP Eligibility Check

"*" indicates required fields

Order ID*

The Order ID must correspond to the Order number found on your OTP receipt/invoice email.

Personal Details

Your Name*

Prefix First Last

Date of Birth*

Your Email Address*

Your Phone Number*

Your Postal Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

ID check (certified copy of passport)*

Accepted file types: jpg, gif, png, pdf, Max. file size: 16 MB.

Upload Photo (optional)

Accepted file types: jpg, gif, png, jpeg, Max. file size: 16 MB.

Overseas Professional Experience

Job Title

Start Date

End Date

Hospital / Company Name

Hospital / Company Address

Manager's Name

Manager's Contact Phone

Manager's Contact Email

Upload certified letter of attestation from Head of Perfusion Department*

Max. file size: 128 MB.

Upload certified letter from senior cardiothoracic surgeon at overseas hospital*

Max. file size: 128 MB.

Upload signed letter from Head of Cardiothoracic unit*

Max. file size: 128 MB.

Upload CV*

Max. file size: 128 MB.

Education & Certification Details

Highest level of education*

Select Qualification from List*

If the degree you have completed is not on this list, formal AQF assessment is required. Please apply for this at https://internationaleducation.gov.au/services-and-resources/services-for-individuals/qualifications-assessments/pages/qualification-assessment.aspx

Degree Details - Country*

Degree Details - Institution*

Perfusion Degree*

Upload certified copy of degree*

Max. file size: 128 MB.

AQF level 7 or greater in perfusion-related field https://www.aqf.edu.au/framework/aqf-qualifications

Upload certified copy of full academic transcript (with individual units of study listed)*

Max. file size: 128 MB.

Upload copy of other degree(s)

Max. file size: 128 MB.

Select country of certification*

Upload certified copy of perfusion certification*

Max. file size: 128 MB.

Date CCP conferred*

Date CCP expires*

Upload certified letter of attestation from perfusion governing body*

Max. file size: 128 MB.

Upload logbook of last 3 years of bypass cases (minimum 150 cases)*

Max. file size: 128 MB.

Official Translation of Documents

Upload any document supplied which is not in English, in both the original language and translated into English in accordance with the Translated Documents Policy.

Max. file size: 128 MB.

English Language Proficiency

Upload English Language Proficiency Certificate

Max. file size: 128 MB.

As per the OTP Policy.

Prospective Employment

Please provide prospective employer details here

Upload the offer of employment letter from the prospective employer

Max. file size: 128 MB.

Mandatory Declaration

Applicant Agreement*

I, the undersigned, hereby state I have undertaken the Clinical Activity and Professional Activity, as provided by me and herewith supplied. I declare, • I have read and understood the ANZCP Code of Ethical Practice; the ANZCP Code of Professional Conduct, and the ANZCP Mandatory Declarations Policy. I undertake to abide by these professional standards. • I have not been convicted, nor currently facing charges in any court in Australia and New Zealand, or elsewhere, of any offence punishable by imprisonment for a term of 3 months or longer. • I know of no information that could cause the Australian and New Zealand College of Perfusionists not be satisfied that I am fit to practice and am a competent person to be a certified member of ANZCP. • All information I have provided is true and correct to the best of my knowledge. • I agree to notify ANZCP if information relating to any of the above changes as soon as practical. • I understand that a false declaration will result in review by the Complaints Committee.

OTP Eligibility Check Application (Phase 1)