| Section 1 - Personal details: |
| Family Name: |
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Given Names:
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| Preferred Name: |
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| Address: |
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| Post Code: |
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Tel (Home):
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| Tel (Business): |
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| Tel (Mobile): |
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| Email: |
(all correspondence via email) |
| Are you legally entitled to
work in Australia?
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| Citizen?
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| Permanent Resident?
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| Work Permit/Expiry Date :
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Please indicate which Graduate
Registered Nurse Program you are applying for:
To select more than one hold down the Ctrl
key then click on your choices.
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| If successful with this application
what date could you commence employment?
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If your application is successful
please indicate the best method of communicating interview
time and date
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Please indicate the hours
of employment you are interested in working during your
Graduate Program?
Full Time (38 hrs/week)
Part Time (please indicate how many hours a week as below)
If part time please indicate how many days or hours
a week you are interested in working i.e. 4 days a
week or 32 hours (N.B. To facilitate orientation part
time employees are requested to work full time hours
for the first month).
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| As a participant on the graduate
program you will be required to work shift work i.e. morning,
evening, nights and weekends. Is there any reason that
you would not be able to undertake this requirement?
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| If yes please give details |
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| How Did You Hear About Us?
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| If other, please provide details:
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| Education |
| Tertiary
Qualifications (Academic transcripts will need
to be provided at interview) |
| Course Title Start
Date Finish Date Grade
Point Average Institution |
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| TAFE/Recognised
College (Record of Results will need to be provided
at interview) |
| Course Title Start
Date Finish Date Institution |
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| Practicuum
Placements |
| Please indicate your practicuum
placements over the previous year. |
| Health Care
Facility Type
of Placement Month/Year Time
Period |
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| EMPLOMENT HISTORY |
| Please provide your employment
history (include any full-time, part-time or casual work,
nursing related or otherwise. |
| Employer Position Duration Hours
per week |
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| REFEREES |
| Please give the name, telephone
number and email address (if possible) of two recent work
referees who have supervised you e.g. a clinical facilitator
from a recent practicum placement and a manager from part
time employement. |
Name:
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| Title: |
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| Employer: |
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| Telephone number: |
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| Email Address: |
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| Has the referee given permission for contact?
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Name:
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| Title: |
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| Employer: |
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| Telephone number: |
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| Email Address: |
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| Has the referee given permission
for contact?
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Employee
Referee Consent
Do you consent to Greenslopes Private Hospital discussing the information
contained in your application with the referees listed?
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| PERSONAL
AND PROFESSIONAL INTERESTS |
| Some of my personal and professional
interests/activities include: |
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| PLEASE COMPLETE
THE FOLLOWING STATEMENTS |
| My short-term career goals are: |
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| My long-term career goals are: |
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| I have shown commitment personally
and professionally by : |
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| I would like to be considered
for a position on the Greenslopes Private Hospital Graduate
Nurse Program because: |
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| EMPLOYEE HEALTH
RECORD |
| Is there any
reason or medical condition that may impair your ability
to perform the job you are applying for?
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| If yes, please provide details: |
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| Declaration |
I declare that the information
I have given is true and correct and I have not witheld
any relevant information you should be aware of when
considering whether to employ me. I understand that you
could terminate my employment if you find that I have
given you untruthful, inaccurate or misleading information.
If required, I agree to a medical examination at any time during my
employment. A medical officer will be nominated by Greenslopes Private
Hospital. I understand that this will be done in the best interests
of my health and safety of my work colleagues and patients.
I authorise Greenslopes Private Hospital to obtain
any information and documents relevant to any injury,
illness or medical condition I may sustain during the
period of my employment with Greenslopes Private Hospital
which may be in the possession of the following:
1. This or another hospital; or
2. Any ambulance service; or
3. A doctor, provider of treatment or rehabilitation service or person
qualified to assess cognitive, functional or vocational capacity; or
4. A previous employer; or
5. Insurers that carry on the business of providing Workers Compensation
Insurance, Compulsory Third Party Insurance, personal accident or illness
insurance, or insurance against the loss of income through disability,
superannuation funds or any other type of insurance; or
6. A department, agency or instrumentality of the Commonwealth or the
State.
I understand that if I am employed this application
and my resume will become a permanent document of my
personnel file. If I am not successful in obtaining
employment this document will be stored and destroyed
after six months.
I check the declaration box to confirm I have read and agree with the
above conditions. |
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