Job Application Form - Registered Nurse
Title
*
-- select one --
Mr
Mrs
Miss
Ms
Dr
Rev
Other
No Salutation
First Name
*
Last Name
*
Street Address
*
Suburb
*
City
*
State / Province / Region
*
Select an Option
Northland
Auckland
Waikato
Bay of Plenty
Gisborne
Hawke's Bay
Taranaki
Whanganui
Wellington
Marlborough
Nelson
West Coast
Canterbury
Otago
Southland
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 License
*
None
Learner's License
Restricted License
Full License
International License
International Expiry Date
Do you have any License Restrictions?
Nationality
*
-- select one --
Afghan
Albanian
Algerian
American
Andorran
Angolan
Antiguans
Argentinean
Armenian
Australian
Austrian
Azerbaijani
Bahamian
Bahraini
Bangladeshi
Barbadian
Barbudans
Batswana
Belarusian
Belgian
Belizean
Beninese
Bhutanese
Bolivian
Bosnian
Brazilian
British
Bruneian
Bulgarian
Burkinabe
Burmese
Burundian
Cambodian
Cameroonian
Canadian
Cape Verdean
Central African
Chadian
Chilean
Chinese
Colombian
Comoran
Congolese
Costa Rican
Croatian
Cuban
Cypriot
Czech
Danish
Djibouti
Dominican
Dutch
East Timorese
Ecuadorean
Egyptian
Emirian
Equatorial Guinean
Eritrean
Estonian
Ethiopian
Fijian
Filipino
Finnish
French
Gabonese
Gambian
Georgian
German
Ghanaian
Greek
Grenadian
Guatemalan
Guinea-Bissauan
Guinean
Guyanese
Haitian
Herzegovinian
Honduran
Hungarian
Icelander
Indian
Indonesian
Iranian
Iraqi
Irish
Israeli
Italian
Ivorian
Jamaican
Japanese
Jordanian
Kazakhstani
Kenyan
Kittian and Nevisian
Kuwaiti
Kyrgyz
Laotian
Latvian
Lebanese
Liberian
Libyan
Liechtensteiner
Lithuanian
Luxembourger
Macedonian
Malagasy
Malawian
Malaysian
Maldivan
Malian
Maltese
Marshallese
Mauritanian
Mauritian
Mexican
Micronesian
Moldovan
Monacan
Mongolian
Moroccan
Mosotho
Motswana
Mozambican
Namibian
Nauruan
Nepalese
New Zealand European
New Zealand Maori
Ni-Vanuatu
Nicaraguan
Nigerien
North Korean
Northern Irish
Norwegian
Omani
Pakistani
Palauan
Panamanian
Papua New Guinean
Paraguayan
Peruvian
Polish
Portuguese
Qatari
Romanian
Russian
Rwandan
Saint Lucian
Salvadoran
Samoan
San Marinese
Sao Tomean
Saudi
Scottish
Senegalese
Serbian
Seychellois
Sierra Leonean
Singaporean
Slovakian
Slovenian
Solomon Islander
Somali
South African
South Korean
Spanish
Sri Lankan
Sudanese
Surinamer
Swazi
Swedish
Swiss
Syrian
Taiwanese
Tajik
Tanzanian
Thai
Togolese
Tongan
Trinidadian or Tobagonian
Tunisian
Turkish
Tuvaluan
Ugandan
Ukrainian
Uruguayan
Uzbekistani
Venezuelan
Vietnamese
Welsh
Yemenite
Zambian
Zimbabwean
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
Qualifications
Please select all those that apply
Associate Degree
Bachelor's Degree
Graduate or Professional Degree
Other
Prefer not to say
None of the above
Medical Skills
Please select all those that apply
Cannulation Experience
IV Management Experience
InterRAI Assessment Trained
Catheterisation Certification
EKG
Nutrition, NG/PEG Feeding
Ostomy Care
Suctioning and airway care
Traction Equipment
Mickey Feeding Tube
Other
None of the above
What are your current work commitments?
Medical Screening tests
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
To gain access to DHB facility sites there are a range of medical screening tests that need to be known
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
Who Referred you?
First
Last
How did you hear about us?
-- select one --
Google
NZ Herald App
Printed Brochure / Advertisement
A Friend Referred Me
Facebook
TradeMe
SEEK
Kiwi Health Jobs
A Recruitment Agency
Other
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
Please specify (Include details of conviction/charge, date of occurrence, outcome etc)
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
Submit
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