Application for Employment
Employment Application

Personal Details

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Work Related Details

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Registered Nuses/Enrolled Nurses/Allied Health Professionals/Medical Staff

Professional References

Please nominate at least two referees from previous employment/s

Qualifications

Employment History

This section is applicable to Support Workers/Care Assistants only

Do you have previous experience in:

Pre Employment Immunisation Screening

Please complete the following questionnaire if you will have resident contact during your employment, including entering resident's rooms or working in resident contact areas:

(The purpose of this questionnaire is to validate immunisation status and screening requirements prior to employment and to ensure that the work place is as far as practicable, safe for employees.)

Section 1. Please answer by ticking the application box:

1.1 Chicken Pox

1.2 Hepatitis B
1.3 Eczema

Section 2. Laboratory Screening Requirements

2.1 Multiple Resistant Staphylococcus aureus (MRSA) screening

If YES, please provide the following details:
Please note: Any statement found to be false or deliberately mileading may invalidate a worker's compensation claim.

Additional Information

Health

Certification