HCA Application Form

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Job Application Form - Health Care Assistant

Title*

First Name*

Last Name*

Street Address*

Suburb*

City*

State / Province / Region*

ZIP / Postal Code*

Mobile*

Landline / Additional Phone*

Email*

Current Mode of Transport*
Public Transport
Personal Car
Other

Eg. How would you normally get to work?

Drivers Licence*
None
Learner's Licence
Restricted Licence
Full Licence
International Licence
Do you have any Licence Restrictions?

Nationality*

Eligibility to work in New Zealand*
I am a New Zealand or Australian Citizen
I am a permanent resident of New Zealand
I hold a valid work visa with conditions allowing work in New Zealand
I hold a valid student visa with conditions allowing work in New Zealand

Locations where I am interested in working
Auckland Central
Northern Auckland
South Auckland
West Auckland
Cambridge
Hamilton
Huntly
Katikati
Matamata
Rotorua
Tauranga
Te Awamutu
Te Kuiti
Te Puke
Thames Coromandel
Tokoroa
Waihi
Ashburton
Cantebury
Christchurch
Greymouth
Hokitika
Lincoln
Northland
Rangiura
Rolleston
Timaru
Westport
West Coast
Whangarei
Other (Please note in anything else you would like us to know at the bottom of this form)

Skills
Please select all those that apply
Manual Handling Experience
Hoist Experience
Resthome Experience
Hospital Experience
Dementia Experience
Mental Health Experience
IHC Experience
Palliative Experience
None of the above

Health Related Qualifications
No Formal Health Qualifications
ACE
Level 2 Certificate HCA (NZ Equivalant)
Level 3 Certificate HCA (NZ Equivalant)
Level 4 Certificate HCA (NZ Equivalant)
Bachelors Degree
Other

eg. if you selected other then please provide details

What are your current work commitments?

Medical Screening tests
To gain access to DHB facility sites there are a range of medical screening tests that need to be known
Hepatitis B Immunity
MRSA Status
TB Status
Current Flu Vaccine
MMR Vaccine (Measles/Mumps/Rubella)
dTpa Vaccine (Tetanus/Dipheria/Petussis)
Varicella
Covid-19 Vaccination
None of the above

Referee One*
Name

Job Title and Company/Relationship

Email or Phone Number

Referee Two*
Name

Job Title and Company/Relationship

Email or Phone Number

Were you referred by a Nova Staff Member?
Yes
No

How did you hear about us?

CV and Supporting Documents*

Please upload relevant files such as C.V., cover letter or educational material relevant to your application
Anything else you would like us to know?

Part of our companies hiring process is to complete a criminal history check. Do you have any present civil/criminal convictions; not including any that are concealed under the Criminal Records (Clean Slate Act); or any civil/criminal charges pending?
Yes
No
Before you submit this application form, please confirm the following. The informaton supplied by me in this application and in any resume or other document submitted is given voluntarily and is to the best of my knowledge true, accurate and complete in all respects.
Yes
No

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