AUSTRALIAN INSTITUTE OF MEDICAL SCIENTISTS

Application for Assessment of Professional Skills & Qualifications

Medical Laboratory Scientist (ANZSCO 234611)
Medical Laboratory Technician (ANZSCO 311213)

APPLICANTS ARE ADVISED TO READ THE GUIDELINES BEFORE COMPLETING THIS APPLICATION.
ALL INCORRECT APPLICATIONS WILL NOT BE PROCESSED.

PERSONAL INFORMATION
Full Name
(as shown in your passport)

Family Name: …………………………………………………………………………………………………………………………… ………………………………………………………………………..

Given Name:…………………………………………………………………………………………… …………………………………………………………………………………………………………..

Have you been known by any other names?
(including name before marriage, or aliases)

No  Yes  (if yes, give details and attach certified proof of name change)
Country of Birth:
Date of birth: …… / …... / ………. Sex: Male  Female 
…………………………………………
Your main language: Country of permanent residence: Are you currently living in Australia?

………………………………………… …………………………………………………………………………… ………………………………………………………………

CONTACT INFORMATION
CONTACT 1
Contact details of the applicant:

Postal address:

………………………………………………………………………………………………………………………………………………………………………………………………………………….…………

……………………………………………………………………………………………………………………………………………………… Country …………………………………………………..…

Contact telephone numbers and email address:
(include country code, area code and extension numbers as applicable)

Mobile: ………………………………………………………………………………………………………… …….………………………………..

Home: ……………………………………………………………………………………………………………………………………………………

Work: …………………………………………………………………………………………………………………………………….………………

E-mail: ……………………………………………………………………………………………………………………………………..……………

CONTACT 2 (if applicable)

Contact details of migration agent or a person acting on behalf of the applicant:

Note: A letter of authority from the applicant is required for correspondence to be issued to t his contact person. The applicant may be
contacted by this office directly if it considered necessary by AIMS.

Postal address:

……………………………………………………………………………………………… ………………………………………………………………………………………………………………….…………

………………………………………………………………………………………………………………………………………………………Country ………………………………………………………
Contact telephone numbers and email address:
(include country code, area code and extension numbers as applicable)

Mobile: …………………………………………………………………………………………………………………………………………………..

Home: ……………………………………………………………………………………………………………………………………………………

Work: …………………………………………………………………………………………………………………………………….………………

E-mail: ……………………………………………………………………………………………………………………………………..……………
Please indicate preferred contact for correspondence relating to this application:

Contact 1  Contact 2 
Note: All correspondence will be sent to the applicant (contact 1) if no indication is made in this question

For m AP SQ. v 4
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 GENERAL EDUCATION DETAILS
Which years did you start and finish school? Start :………… Finish:…………

Number of years you were at Primary School? ………… Number of years you were at secondary school? …………

Please Note: It is not necessary to provide documentary proof or course transcripts of your primary and secondary education.
PROFESSIONAL EDUCATION DETAILS
Give details of all tertiary level courses you have completed. Attached certified copies of degrees and certificates and comp lete course
transcripts for each qualification. All documents in a language other than English must be accompanied by an offi cial English
translation.

1 s t Qualification you obtained (in English): ……………………………………………………………………………………………………………………….. ……………………..…..

1 s t Qualification you obtained (in original language): ……………………………………………………………………………………………………………………………………

Name and Address of training institute: ………………………………………………………………………………………………… …………………………………………….. ……….

Country of training institute: ………………………………………………………………………………………………………… …………………………………………………………….….

Normal length of full-time course (state years and semesters): ………………………………………………………………………………………………………….. ……..

Length of time you took to complete the course (state years and semesters): …………………………………………………………………………………………..

Date Started: ……… / ……… / ……………. Date Finished: ……… / ……… / …………….

Studied Full-time:  Studied Part-Time: 

Was a period of compulsory practical or clinical experience a requirement of the course? Yes*  No 

*if yes, length of time involved e.g. show whether years, months, weeks or semesters:………………………………………………..

2 n d Qualification you obtained (in English): …………………………………………………………………………………………………….…………………………………………..…..

2 n d Qualification you obtained (in original language): ……………………………………………………………………………………………………………………..………………

Name and Address of training institute : ………………………………………………………………………………………………………….……………………………….……………….

Country of training institute: …………………………………………………………………………………………………… …………………………………………………… ………………….

Normal length of full-time course (state years and semesters): …………………………………………………………………………………………………………….……..

Length of time you took to complete the course (state years and semesters): …………… ………………………………………….…………………………………..

Date Started: ……… / ……… / ……………. Date Finished: ……… / ……… / …………….

Studied Full-time:  Studied Part-Time: 

Was a period of compulsory practical or clinical experience a requirement of the course? Yes*  No 

*if yes, length of time involved e.g. show whether years, months, weeks or semesters:………………………………………………..

3 rd Qualification you obtained (in English): ……………………………………………………………………………… ………………………………………………………………..…..

3 rd Qualification you obtained (in original language): ………………………………………………………………………………………………………………………………………

Name and Address of training institute : ……..…………………………………………………………………………………………………………………………………………………….

Country of training institute: …………………………………………………………………………………………………………………………………………………………………………….

Normal length of full-time course (state years and semesters): …………………………………………………………………………………………………………….……..

Length of time you took to complete the course (state years and semesters): …………………………………………………………………………………………....

Date Started: ……… / ……… / ……………. Date Finished: ……… / ……… / …………….

Studied Full-time:  Studied Part-Time: 

Was a period of compulsory practical or clinical experience a requirement of the course? Yes*  No 

*if yes, length of time involved e.g. show whether years, months, weeks or semesters:………………………………………………..

Please Note: If you have more qualifications that you wish to include, plea se attach a separate sheet containing details of all further
qualifications. Please sign and date each additional page you include in this application.
 PROFESSIONAL EMPLOYMENT DETAILS
Provide a summary of your professional experience over the last ten (10) years. Please include details of:

 the dates of each period of employment

 the name of the employer, and the nature
and country of location of the business
 your job title or description
 the nature of your employment, including most
important tasks performed or projects complete
 duty statement

Include certified copies of proof of employment stating job title or description, duties undertaken and number of hours worked per
week. All documents in a language other than English must be accompanied by an off icial English translation.

Employment from ………..to…………. Employer:…………………………………………………….…………………………………………………………………………………..………..

Address of Employer: ………………………………………………………………………………… ………………………………………………………………………………………………………..

Job Title or Description: ………………………………………………….…………………………………………………………………………………………………………………………………

Tasks:

………………………………………………………………………… ……………………………………………………….. ………………………………………………………………………………………………………..

………………………………………………………………………… ……………………………………………………….. ………………………………………………………………………………………………… ……..

………………………………………………………………………… ……………………………………………………….. ………………………………………………………………………………………………………..

………………………………………………………………………… ……………………………………………………….. ………………………………………………………………………………………………………..

Employment from ………..to…………. Employer:…………………………………………………….………………………………………………………………………………….………..

Address of Employer: ……………………………………………………………………………………………………………………………………… ………………………………………………..

Job Title or Description: ………………………………………………….…………………………………………………………………………………………………………………………………

Tasks:

……………………………………………… ………………………… ……………………………………………………….. ………………………………………………………………………………………………………..

………………………………………………………………………… ……………………………………………………….. ………………………………………………………………………………………………………..

………………………………………………………………………… ……………………………………………………….. …………………………………………………………………………………………… …………..

………………………………………………………………………… ……………………………………………………….. ………………………………………………………………………………………………………..

Employment from ………..to…………. Employer:…………………………………………………….…………………………………………………………………………………..….…..

Address of Employer: ………………………………………………………………………………………………………………………………………………………………………………….……..

Job Title or Description: ………………………………………………….………………………………………………………………………………………………………………………… .………

Tasks:

………………………………………………………………………… ……………………………………………………….. ………………………………………………………………………………………………………..

………………………………………………………………………… ……………………………………………………….. ………………………………………………………………………………………………………..

………………………………………………………………………… ……………………………………………………….. ………………………………………………………………………………………………………..

………………………………………………………………………… ……………………………………………………….. ………………………………………………………………………………………………………..

Note: If you have more professional experience that you wish to include, please attach a separate sheet containing details of this
professional experience. Please sign and date each additional page you include in this application.
 REGISTRATION / LICENSURE DETAILS (if applicable)
First registration:

Name of authority of first registration: ……………………………………………………………. ……………………………………………..………………………………………………

Country: ……………………………………………………………………………………………………………………………………………………………………………………………………………..

Date started: ……… / ……… / …………….

Most recent or current registration

Name of authority of most recent or current registration: ………………………………………………….…………………….……………………………………………………

Country: ……………………………………………………………………………………………………………………………………………………………………………………………………………..

Date started: ……… / ……… / …………….

Have you ever been refused a licence or registration, or had a licence or registration withdrawn?

 No  Yes (if yes, give details)

………………………………………………………………………………………………………………………………………………… .………………………………………………………………………….

Give the names of any professional bodies of which you are a member, and your membership title:

……………………………………………………………………… ……………………………………………………………………………………………………………………………………………………..
IMPORTANT CHECKLIST
You must include the following documents (together with certified English translations if applicable)

 Certified* copies of all qualification papers (such as degrees, diplomas, certificates etc)

 An official certified* record of educational courses completed, showing: su bjects, hours, examination results, and where
applicable, details of practical and clinical education.

 Certified copy of IELTS (general or academic) test result showing an overall band score of 7.0 or better (or TOEFL (95 points),
or Pearson PTE Academic (65 points)). There are no exemptions to this requirement.

 Certified* evidence of your professional work experience and references from employers or, if you are self -employed, two
professional Colleagues.

 Certified* official copies (if applicable), of:

 Original and current registration or licensure
 Internship
 Change of name

 Certified* copy of photographic identification. (passport or identification card)

 Three (3) Passport size photographs endorsed on the reverse side with your name and signature.

 Assessment Fee AUD800.00

 You must submit three (3) sets of the application form and all documentation, which includes the completed application form
and all originally correctly certified documentation ‘set 1’ plus two (2) additional photocopies of ‘set 1’.

*Certified documents:

 AIMS requires originally certified copies of ALL documentation submitted.

 Documents certified in Australia must be certified by a Justice of the Peace or a Notary Public. Documents certified in a
country other than Australia must be certified by a Notary Public or an official of an Australian Embassy or Consulate . There
are no exemptions to these rules. NB: submitting incorrectly certified documents will delay your application .

INCOMPLETE & INCORRECT APPLICATIONS WILL NOT BE ACCEPTED

 PAYMENT INFORMATION

Payment must be in Australian dollars and all payments are non-refundable

(Cheques or drafts must be in Australian currency, drawn on an Australian bank and free of all charges and made payable to Australian Institute of Medical Scientists)

Please refer to our website for current fees

Payment method:
Please tick ()

 Cheque / Money Order / Draft

 Online Payment

 Credit Card (complete section below)

Credit Card : Please tick () box: Visa MasterCard

Card No:

Expiry Date (mm/yy) / CVV Number

Cardholder Name: Signature:

(As it appears on the card)

(Office Use Only)

DECLARATION

I declare that the information I have supplied on this form and the enclosed documents is complete and correct.

I acknowledge that AIMS may seek further information or validation of the information and documents provided with this
application from third parties and that AIMS may forward all or part of this application to the Department of Immigration
and Border Protection (DIBP). AIMS will also inform DIBP of any concerns it may have as to the validity or authenticity of
any part of this application or th e attached documents. AIMS reserves the right to inform assessment status to relevant
third parties, however, your personal details will remain confidential. To view our privacy policy visit:
www.aims.org.au/privacypolicy

Signature: …………………………………………………………………… ………………………………………………..………………………. Date: ……. / ……… / …………………..

SUBMIT

Postal Address:
Australian Institute of Medical Scientists
PO Box 1911
Milton QLD 4064
Australia

Courier Address:
Australian Institute of Medical Scientists
7/31 Black Street
Milton QLD 4064
Australia