Adc Assessment
Adc Assessment
Adc Assessment
Key
Note. Highlights additional information.
Before completing this form, please read all sections of the form including the checklist and explanatory notes.
Please complete the application form in English. Please complete in CAPITAL LETTERS using a blue or black pen.
Please post the application form, including the necessary supporting documentation, to the Australian Dental
Council (ADC) once completed. As we need to assess the form and the certified supporting documentation, we
cannot accept scanned or emailed application forms.
Sections accompanied by indicate areas where supporting documentation is required as evidence of the
information you have supplied. Please ensure all supporting documentation listed in the Checklist is
provided.
Processing time for your application: Please allow a turnaround of approximately 8 weeks from date of receipt.
1. Please supply two certified, colour passport sized photographs of yourself for Please staple photographs here.
the purposes of identification.
Photographs must not be older than nine (9) months.
Photographs must be certified on the back according to the certification
guidelines, including:
• the statement This is a true photograph of [INSERT NAME]
• AND the date, full name, signature, title, and contact details of the
authorising officer.
The Certification of document guidelines is available here.
3. Surname/family name
4. Given name(s)
5. Middle name(s)
Page 1 of 12
Application for initial assessment of
overseas qualified dental practitioner
Form AS-1 V2
SECTION C. APPLICANT’S PERSONAL CONTACT DETAILS
9. Please provide the correct address for the applicant named in Section B
Suburb/Town/City State/Territory/Province
Country Postcode
Applicant email
10. It is not necessary to, but you may nominate a person, or an agent, to receive all correspondence regarding the
dental practitioner assessment process on your behalf. If you choose to do so, you will need to complete an Authority
to act form.
Do you wish to nominate someone to act on your behalf? Please mark ☒ one option only.
☐ Yes. I have complete and attached an Authority to act form and understand all correspondence regarding the
dental practitioner assessment process will be forwarded to my chosen nominee. This form is available from our
website adc.org.au under Assessment Publications.
☐ No, I do not wish to have someone act on my behalf.
Please note: A new authority to act must be nominated with each application.
12. Skills Assessments: The ADC is authorised by the Australian Department of Home Affairs as the assessing authority for
Mark option most overseas trained dentists who intend to migrate to Australia.
appropriate to
If you are a dentist please indicate below the purpose of your application
your application
(you may only select ☐ Registration only
one)
☐ Skills assessment only (for migration)
☐ Registration and skills assessment
Please note: the ADC does not conduct skills assessments for other dental practitioners. For this,
please contact VETASSESS.
Page 2 of 12
Application for initial assessment of
overseas qualified dental practitioner
Form AS-1 V12
SECTION F. DENTAL QUALIFICATION DETAILS
Suburb/Town/City State/Territory/Province
Country Postcode
Please note: If your university has provided your hours as credits, you will need to provide further information in order to
determine the total theoretical, clinical and self-directed hours undertaken. This may include:
• Total number of credits
• The division of these credits into:
o Theory/lecture credits
o Clinial/lab credits
o Self-directed learning credits (if applicable).
• A definition of how 1 credit equates to actual hours per week (this may differ between theory, clinical and self-
directed learning credits).
• The number of academic weeks in a semester .
Page 3 of 12
Application for initial assessment of
overseas qualified dental practitioner
Form AS-1 V2
SECTION FI. THIS SECTION SHOULD BE COMPLETED BY DENTAL HYGIENE/DENTAL THERAPY CANDIDATES ONLY
ATTACH SYLLABUS
Dental hygiene practice clinical skills Dental therapy practice clinical skills
(tick box to indicate the subjects completed) (tick box to indicate the subjects completed)
☐ Periodontics ☐ Exodontia
SECTION FII. THIS SECTION SHOULD BE COMPLETED BY DENTAL PROSTHETIST CANDIDATES ONLY
ATTACH SYLLABUS
If you have a qualification as a dental technician relevant to your dental prosthetist qualification, please
provide evidence of this
Page 4 of 12
Application for initial assessment of
overseas qualified dental practitioner
Form AS-1 V2
SECTION G. REGISTRATION/LICENCE HISTORY
22. Licensing exam Did you sit and pass a national or regional licensing/registration examination to gain
(if applicable) registration?
If yes, state the name of the examination and the examining authority
Please ensure you write the name of the registering body in this section, not your legal name.
*If you answered Yes to any of the above questions, please provide a signed written
explanation.
28. Letter of Good The ADC requires an additional Letter/Certificate of Good Standing from the
Standing registration/licence authority the applicant was most recently registered with.
☐ Yes, I have requested a Letter/Certificate of Good Standing to be posted to the ADC.
The applicant
cannot submit this The ADC will not accept this document if it is provided by the applicant. The
document. registration/licence authority must send this document directly to the ADC. If the document
Is not in English, the ADC will arrange for translation at no extra cost.
It is recommended that letters of good standing are posted to the ADC after your initial assessment
application has been submitted.
The letter of good standing is valid for three months from the date that it was issued by the registering
authority.
If your letter of good standing arrives before your application, it will be filed safely and combined with
your application on receipt. If your letter of good standing arrives after your application and we can
match it to your application, you will receive an email notification that it has been received.
Page 5 of 12
Application for initial assessment of
overseas qualified dental practitioner
Form AS-1 V2
SECTION H. EMPLOYMENT HISTORY
29. Recency of Have you worked as a dental practitioner in the last five (5) years?
practice
☐ Yes. Please complete the following employment details for each employer.
☐ No. Please submit a signed written statement explaining why you have not worked in the
last five (5) years.
(If you are or have been self-employed, please state and provide details below. Please refer
to the Explanatory Notes and Checklist for more information.)
Employment details – if there are additional employers, please attach these on a new page.
Employer one
Name
Your position
Employer two
Name
Your position
Employer three
Name
Your position
Employer four
Name
Your position
Page 6 of 12
Application for initial assessment of
overseas qualified dental practitioner
Form AS-1 V2
SECTION I. PROFESSIONAL REFERENCES
30. Professional The ADC requires two (2) recent written professional references attesting to your
references competence and good standing as a dental practitioner. Referees must be from employers,
supervisors or tutors. If you were self-employed, referees can be from professional colleagues.
Your references must be provided on the official letterhead (with the full address, telephone,
email and website) of the person, company or government department. References must
include:
• The name and position of the person issuing the reference typed or stamped below the
person’s signature.
• The direct contact number of the person writing the reference.
• The date the reference was issued. (Reference letters must be less than 12 months old.)
Due to a perceived conflict of interest, professional references from family members will not
be accepted.
Email:
Email:
Page 7 of 12
Application for initial assessment of
overseas qualified dental practitioner
Form AS-1 V2
SECTION J. DECLARATION
Please read and ensure you understand the following • I understand that failure to complete all relevant
declaration before signing. sections of this application form, including payment of
the application fee and all supporting documentation,
• I consent to the Australian Dental Council making inquiries may result in delaying the assessment of this
and/or exchanging information with the authorities of any application or refusal of this application.
Australian state or territory, or other country, regarding my
practice as a dental practitioner or otherwise regarding • I understand that the Australian Dental Council reserves
matters relevant to this application. the right to require further documentation to progress
the assessment of this application.
• I undertake to inform the Australian Dental Council of any
changes to my circumstances or details. • I am the person named in this application and all
attached documents.
• I am not subject to any professional disciplinary/legal
proceedings past or pending, except as otherwise • The above statements, information provided on my
specified in Section G. application form and all documentation provided with
this application are true and correct.
• I have read the explanatory notes and authorise the
Australian Dental Council to make any enquiries necessary • I consent to the Australian Dental Council contacting
to assist in the assessment of my application. me for quality control, educational and/or research
purposes.
• I acknowledge that the Australian Dental Council may
verify documents provided in support of this application as
evidence of my identity.
Date (DD/MM/YYYY)
SECTION K. PAYMENT
Applications will not be processed until the assessment fee has been paid in full. A receipt will be issued upon clearance of
payment. Please refer to the current schedule of fees at adc.org.au/practitioner-assessments
Cardholder signature
Page 8 of 12
Application for initial assessment of
overseas qualified dental practitioner
Form AS-1 V2
EXPLANATORY NOTES
You will be notified via email of the outcome of the Applicants must state their full legally registered name
assessment and the next steps in the process. exactly as it appears on their passport. Any change in
name will need to be supported by official
Please note documentation showing the link with previous names (e.g.
To prevent delays in assessment of your application before and after marriage). The ADC does not accept
please read the application form, including the Affidavits/Statutory Declarations for this purpose.
explanatory notes and checklist, carefully and ensure you If the name on your supporting documents does not
have provided all the relevant supporting documentation. match your passport (e.g. includes your father’s name or
Validity period has abbreviated one of your names) and is not
accounted for by other evidence of name change,
Once a renewal of initial assessment application has been please provide a letter from the issuing authority
assessed as complete, it will be valid for seven years from acknowledging that both names refer to you.
the date of completion.
Certification of photographs
Candidates will have seven years to successfully
complete the ADC process (written examination and The photographs submitted must not be older than nine
practical examination). If a candidate does not (9) months. Photographs must be certified on the back
successfully complete the ADC process within seven years according to the certification guidelines and must include
from the date of completion of their initial assessment, the statement ‘true photo’ of [your name], as well as the
they will be required to renew their initial assessment in date, signature, full name, contact details and title of the
order to continue the ADC process. authorised officer).
Page 9 of 12
Application for initial assessment of
overseas qualified dental practitioner
Form AS-1 V2
Translation of Documents Correspondence
Translations in English of all non-English documents must be Please ensure the email address you provide is reliable
provided and attached to the document/s to which they and checked regularly. Candidates who use free internet
refer. The ADC recommends candidates provide providers (Gmail, Yahoo etc.) should properly maintain
translations completed by a translator accredited by the their mailboxes and check junk mail or other filters. The
National Accreditation Authority for Translators and ADC will not be responsible for non-receipt of correctly
Interpreters (NAATI). addressed emails.
Please note
The translator’s details (name, address, etc.) must be
stated in English. Translations must be provided in full. The
ADC will not accept extract or partially translated
documents.
Applicant’s Personal Details and Identification
ALL applicants must complete Section B of this application
to ensure accurate information is provided for future use.
Applicants must provide a clear, certified copy of a valid
international passport as evidence of identity.
Assessment of alternative forms of identification occurs on
a case-by-case basis and may or may not be accepted
at the discretion of the ADC.
Agents
The ADC normally deals directly with applicants seeking
an assessment of their overseas qualifications. Australia’s
privacy legislation prohibits the ADC from discussing your
application with third parties unless specifically authorised
to do so by you.
If you want someone, such as a family member or other
agent, to deal with the ADC on your behalf, you will need
to indicate this by completing the ADC’s Authority to Act
form. Once your Authority to Act form has been
processed all correspondence will be sent only to the
person you have nominated and not to you.
Please refer to the ADC’s Authority to Act form which can
be downloaded from the ADC website at adc.org.au
Professional References
You will need to provide two dated professional
references as part of your application. References must
be in writing, be less than 12 months old and attest to your
competence and good standing as a dental practitioner.
The ADC will accept written references made by
employers, supervisors, or tutors. If you were self-
employed, references from professional colleagues will be
accepted. Due to perceived conflict of interest, the ADC
will not accept professional references from family
members.
Page 10 of 12
Application for initial assessment of
overseas qualified dental practitioner
Form AS-1 V2
CHECKLIST
Please check to ensure the following information is completed in your application
Section A ☐ Question 1. Two (2) certified colour passport sized photographs of yourself for the purpose of
identification.
Section B ☐ Questions 2 - 7 A clear copy of the identity page(s) of your current, valid passport.
Section F ☐ Question 13 Degree, diploma or certificate in original language and English translation where
(and Fi &Fii if required
applicable)
☐ Question 16 Official transcript of your primary education course completed in the original
language. Transcripts MUST state:
• applicant’s name
• subjects
• examination results and details
• total theory, clinical and self-directed hours
• course start and completion dates
• language in which course was taught
• copy of course syllabus (where applicable, dental hygiene/therapy and
prosthetist)
• evidence of further training (where applicable, dental hygiene/therapy and
prosthetist).
Section G ☐ Question 22 Results of any national/state/regional board examination for licensure (where
relevant)
Page 11 of 12
Application for initial assessment of
overseas qualified dental practitioner
Form AS-1 V2
CHECKLIST (CONT.)
Please check to ensure the following information is completed in your application
Section H ☐ Question 29 Official work statement must contain the following information from each of your
employers.
• Provided on official letter head which includes full address and contact business
details
• Issue date
• Applicant’s name in full
• Employment start and finish dates
• Confirms the applicant was employed as a registered dental practitioner
• Signed by a recognised Manager/Director.
Or if self-employed
• Appropriate evidence, such as a letter from your accountant or registering
authority detailing the dates you have earned income as a dentist and
supporting documents such as tax records, business registration certificate.
Or if not employed in the past five (5) years
• (If applicable) a signed written statement explaining why you have not worked
as a dental practitioner in the last five (5) years.
Section I ☐ Question 30 Two (2) recent (dated) written professional references containing the following
information:
• On official letter head of the person, company or government department
providing the reference (including full address and contact business details)
• Date issued (must be less than 12 months old)
• Applicant’s name in full
• Attesting to the applicant’s competence and good standing as a dentist
• Signed by employer, supervisor or tutor or, if you were self-employed, from
professional colleagues.
Post applications and certified documents to: PO Box 13278, Law Courts Vic 8010, Australia
If you plan on sending your documents via courier, please post to Level 6, 469 Latrobe Street,
Melbourne Vic 3000.
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