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Application for Short Term Locum Cover – Urban

Please fill out and submit the form below, one of our Relationship Managers will be in contact with you shortly.

If you prefer to print out a form please download from here and fax/email your completed form and signed copy of Terms and Conditions to:
Fax: 04 472 0904
Email: enquiries@nzlocums.com

Download form

  • Dates Applied For

    Dates applied for are as follows. While we can’t guarantee to be able to provide a locum for your first choice of dates, we will do our utmost to secure a break for you during one of the three listed date ranges.
  • DD slash MM slash YYYY
  • DD slash MM slash YYYY

  • Times

    Please select below the actual sessions requiring cover (including after hours).

    Week 1

  • DD slash MM slash YYYY

  • Week 2

  • DD slash MM slash YYYY
  • Applications for locums are prioritised on date received at the Network. An application does not guarantee a placement. If you have any questions, telephone us on free call 0800 695 628.
  • View terms and conditions

    For full Terms and Conditions please contact Luke Baddington
  • DD slash MM slash YYYY

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