Registration Bridging Program for Overseas Qualified Registered Nurses

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Solomon Scott
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1 YOU MUST COMPLETE ALL SECTIONS. USE BLOCK LETTERS AP P LICAT ION FO RM 1. PERSONAL DETAILS. Mr Mrs Miss Ms Other:.. Your name must appear on this application exactly as it appears in your passport PERMANENT ADDRESS: If not the same as the Mailing Address No. and street: Family Name: Given Name: Other/Middle Name: Suburb/City: State: Telephone: Fax: Mobile: Zip/Postcode: Female Male * Date of Birth: DD/MM/YYYY Country of Birth: MAILING ADDRESS: Do not use PO Box and advise IHNA if you change your address during the year 2. AGENT DETAILS Are you applying through an agent? Include agent stamp in the box below No. and street: Is your agent an authorised agent of IHNA? Don t know Suburb/City: AGENT S STAMP HERE State: Zip/Postcode: Telephone: Fax: Mobile: IHNA Reference. (For office use only) * * preferred communication with applicants and/or agents Page 1 of 5

2 3. INTAKE AND VISA DETAILS Which intake do you intend to apply for? Year: Month: Do you have Australian Permanent Residency (PR) status? Yes If Yes, please provide evidence of this status with your application form. No If no, what is the type of visa you currently hold [please provide evidence] No If yes, year you are likely to gain PR: YYYY Citizenship: Country of Application: 4. ENGLISH LANGUAGE PROFICIENCY Is English your first language? Was English your language of instruction at secondary and tertiary level? International applicants must provide documented evidence of completing one of the following English proficiency tests. Tick the one you are providing. IELTS Academic: achieving an overall minimum score of 7.0 with minimum individual score of 7.0 in writing, speaking, reading and listening; or OET: Nursing version level B or above in a single sitting. 5. FINANCIAL SUPPORT Please indicate your source of financial support and for invoice purposes please attach information of person or organisation paying fees. I am fully sponsored by my home government (attach documentation) I am fully sponsored by an employer (attach documentation) I am a private student supported by myself/ my family I am a private student supported by an approved bank loan 6. HOW DID YOU HEAR ABOUT Internet Agent: IHNA? Friend/relative: Advertisement: Other: 7. DISABILITY Do you have a disability? If Yes, please state: Date of Test: DD/ MM/ Y Y Y Y Institution: Overall Score Achieved: Listening Score: Reading Score: Writing Score: Speaking Score: Page 2 of 5

3 8. NURSING QUALIFICATIONS 8a. You are qualified as : Registered Nurse Mental Health Nurse Midwife Enrolled Nurse Graduate Nurse 8b. List below all your Nursing Qualifications. Attach certified copies of your Nursing Graduation Certificate, Diploma or Degree as well as the transcript or academic record showing your grades for the nursing diploma or degree. Experience date is considered from the date of Nursing Registration. See Checklist on Page 5. Qualification Type of Certificate/Award & Institution Country of Qualification and Language of instruction Duration of Course From To 8c. List below your experience as a qualified nurse. Please supply statements from employers and a reference. See Checklist on Page 5 Employer Position Held Area of Experience From Duration To Page 3 of 5

4 9. REGISTRATION 9a. Where were you first registered? Please supply a certified copy of your initial registration: Registering Authority: Registration Number: Date of Registration: 9b. Have you ever been registered in Australia? Yes No 9c. Are you currently registered? Yes (give details below) Registering Authority: Registration Number: Date of Registration: No 10. OTHER RELEVANT PROGRAMS, TRAINING OR STUDIES UNDERTAKEN I declare that: 11. DECLARATION to the best of my knowledge, the information provided by me is true and complete. I acknowledge that the Institute of Health and Nursing Australia may vary or reverse any decision regarding admission or enrolment made on the basis of incorrect or incomplete information provided by me. I understand that I am seeking temporary entry into Australia for educational purposes only. I authorise the IHNA to make enquiries about the details associated with this application. I understand the above conditions and am prepared to accept them in full. I understand that I, or my sponsor, will be responsible for the full cost of the program for which I am seeking admission, as well as travel and living costs. I understand that, as part of the program, I will need to travel to health facilities for clinical placement and all cost associated with travelling and accommodation shall be borne by me. Date : DD/MM/YYYY. Page 4 of 5

5 12. CHECKLIST COMPLETE THE CHECKLIST BELOW AND ATTACH ALL RELEVANT DOCUMENTS TRANSLATION OF DOCUMENTS: If documents are in a language other than English, you must have them translated by an official translator before sending them to us. Once the documents have been translated, both the translation and the documents in the original language, should be sent with this application form. CERTIFIED COPIES: If applying by mail, each copy of an original document must bear a statement certifying that it is a true copy of the original by a Lawyer, Justice of the Peace, Peace Commissioner, Commissioner of Oaths, Notary Public, Judge, Magistrate, a member of the Australian Immigration Department, Australian Embassy or Consulate. The person who signs the document must have the legal authority to do so and the statement should also include the appropriate official stamp or seal. It should also include the date of the statement and the name, signature, business contact address and business phone number of the person making the statement. CHECK LIST Certified copies showing completion of training diploma or degree. Current registration certificate with the Nursing Board. Post basic certificates and statements of academic record issued by any other higher education institutions. Document confirming your date of birth: A certified copy of your birth certificate should be provided as proof of date of birth. If you are unable to supply a birth certificate, please supply a certified copy of your passport. Letter from Nurses Board of Victoria/ AHPRA/ NMBWA/ACTNMB confirming acceptance to undertake initial registration program. Evidence of change of name: If the name on any of your documents is not the same as that on the birth certificate, you will need to supply a certified copy of one of the following as evidence of your change of name: marriage certificate, divorce papers or deed poll. English proficiency original or certified copy: See Section 2 for English language proficiency tests accepted for entry to Initial Registration Program Certified copy of nursing graduation certificate, diploma or degree Certified copy of initial registration Resume / CV Minimum 2 Years Nursing Experience with a Minimum of one year experience in a Medical or Surgical ward Professional reference original or certified copy: One professional reference (dated within the last two years and on official letterhead), which includes the following: Dates of employment Areas of experience A statement of your professional competence as a nurse/midwife Name, signature and position of the referee Employment statements original or certified copy: Statements from employers on official letterhead giving dates of employment (must be within the last five years), your area of expertise and where you were working. Passport certified copy: You should supply a certified copy of the page (s) of your current passport verifying your legal name and personal details. Certified copy evidence of Visa Permanent Resident Status Candidates only If you have gained Permanent Residency status in Australia, you should supply evidence of attaining your PR status a certified copy of the page (s) in your current passport verifying your Permanent Residency Status visa. Candidates who do not have PR status can disregard this item on the checklist. PLEASE NOTE THAT DOCUMENTS YOU SUBMIT TO IHNA FOR ASSESSMENT ARE NOT RETURNABLE. Page 5 of 5

Overseas Qualified Nurses Australian Nursing Induction Program

Overseas Qualified Nurses Australian Nursing Induction Program Course Outcome This course is designed to provide participants with the knowledge, skills and understanding to practice as a nurse safely