Application Form (All fields are required)
1. Advertising Avenue:
How did you hear about this opportunity?
2. Work Status:
Legal Entitlement to work in NZ
3. Nursing experience:
How many years' relevant nursing experience do you have?
4. Availability:
If successful, when would you be available to start?
5. Employment Type:
What type of employment are you seeking?
6. Salary expectation:
What is your salary expectation or desired hourly rate for this position?
7. Annual Practising Certificate:
What is your Annual Practising Certificate Number?
8. Professional Conduct:
Have you ever: been referred to/by the Nursing Council for any reason; had conditions placed on your scope of practise; faced charges before the Health Practitioners Disciplinary Tribunal?
9. Prior Selwyn Employment:
Have you worked for the Selwyn Foundation or any of its subsidiaries before?
10. Relatives/Friends:
Have you any relatives or friends currently employed by the Foundation Group?
11. Shift Work:
Are you prepared to work rostered shifts, if required?
12. Products/materials/Equipment:
Are you prepared to handle all products, materials and equipment used in this industry?
13. Hearings:
Are you awaiting the hearing of charges in a civil or criminal court of law?
14. Criminal Offences:
Have you ever been convicted of a criminal offence, including driving convictions? (excluding any convictions under the Clean Slate Act 2002)
15. Dismissal:
Have you ever been dismissed from a position for disciplinary reasons?
16. Medical Information:
Do you know of any reason or suffer from any disability which might affect your ability to perform the duties associated with the job applied for?
17. Medical Information 2:
Have you had any injury or medical condition caused by gradual process, disease or infection, e.g. hearing loss, repetitive strain injuries, sensitivity to chemicals, that may be aggravated or further contributed to by the tasks of this job?
18. Declaration:
I declare that to the best of my knowledge the information provided in this application and in any CV is accurate and I understand that if any false or misleading information is given, I will not be employed, or if employed, may be terminated.
19. Declaration 2:
I consent to the information provided in this application being retained for considering my suitability for other positions which may arise, & consent to the information gained being provided to any member of the Selwyn Foundation Group.
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