FOR OVERSEAS QUALIFIED SOCIAL WORKERS INTENDING TO PRACTICE IN NEW ZEALAND OR WHO HAVE BEEN A RESIDENT IN NEW ZEALAND FOR LESS THAN 12 MONTHS

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1 Application Form FOR OVERSEAS QUALIFIED SOCIAL WORKERS INTENDING TO PRACTICE IN NEW ZEALAND OR WHO HAVE BEEN A RESIDENT IN NEW ZEALAND FOR LESS THAN 12 MONTHS

2 Application Form For overseas qualified social workers intending to practice in New Zealand or who have been a resident in New Zealand for less than 12 months OFFICE USE ONLY Write your name on the back of ONE passport-sized photograph and paperclip here # 1. IDENTIFICATION See Guide te 1 Family name: Given name/first name(s): middle name(s): Other name/previously used name(s): Attach certified evidence if the above names differ from those on your birth certificate, and indicate the reason by ticking the relevant box below. Marriage Civil Union Deed poll Common use (provide statutory declaration) Gender: (please tick) Male Female Birthplace: (town and country as shown on your birth certificate/passport) Birth date: (day/month/year) Ethnicity: ALL APPLICANTS Attach certified copy of your birth certificate Attach certified copy of the relevant identification page(s) of your passport 2. DECLARATION See Guide te 2 I, (Solicitor / Court Registrar / Justice of the Peace / Gazetted Officer*) certify that I have compared the photograph of (applicant) before me, and that in my opinion it is a true and faithful likeness. I am satisfied that the applicant before me is the person to whom the passport relates. Signature of certifying authority: Stamp: Date: Please also provide contact details: Address: Phone: *The same legal professional who signs this Declaration must also certify the copy of your passport

3 3. ADDRESSES See Guide te 3 HOME ADDRESS For office use only will not be published Address: postcode: Phone: (+ international code) MAILING ADDRESS If your mailing address differs from your home address, please give details below. Address: postcode: Phone: (+ international code) NEW ZEALAND ADDRESS IF AVAILABLE Address: postcode: Phone: (+ international code) 4. QUALIFICATIONS See Guide te 4 Part A Overseas social work qualifications Attach certified copy of your primary social work qualification (and certified translation if not in English) Attach certified copy of your official academic transcript (and certified translation if not in English) Attach copy of SWRB n-binding Assessment Outcome (if undertaken) What is your primary social work qualification? Which education institution provided this qualification? In what year did you complete this qualification? What was the usual entry requirement for the qualification? What was the normal length of the qualification if you studied full-time? 2

4 Part B Fieldwork / Practicum See Guide te 5 First fieldwork placement Name of agency: Nature of work undertaken by agency: Duties undertaken during placement: Total number of days: Year completed: Second fieldwork placement Name of agency: Nature of work undertaken by agency: Duties undertaken during placement: Total number of days: Year completed: Third fieldwork placement Name of agency: Nature of work undertaken by agency: Duties undertaken during placement: Total number of days: Year completed: 5. COMPETENCE IN ENGLISH See Guide te 6 Is English one of your first languages? Yes (if you ticked Yes, go to question no 6) (if you ticked, please answer the questions in this section) What is your primary spoken language? Was your secondary schooling completed in English? Yes Was your social work qualification completed in English? Yes I have asked the testing authority to send my IELTS results to the SWRB 3

5 6. CURRENT OVERSEAS LICENCE AND/OR REGISTRATION IN SOCIAL WORK See Guide te 7 Do you have or have you previously had any social work registration(s) and/or licence(s) in other countries? Yes attach certified copies of most recent registration certificate(s)/licence certificate(s) 7. COMPETENCE See Guide te 8 Attach SWRB paper-based overseas competence assessment application 8. CONFIRMATION OF CHARACTER See Guide te 9 Yes, I have sent the Confidential Reference Request form to a referee who meets the criteria outlined in Guide te 9 Professional disciplinary proceedings See Guide te 10 Are you now (or have you ever been) the subject of any professional disciplinary proceedings? Yes write to the SWRB Registrar explaining the circumstances and enclose in a sealed envelope with your application Are you currently under investigation for any matter that may become the subject of professional disciplinary proceedings? Yes write to the SWRB Registrar explaining the circumstances and enclose in a sealed envelope with your application If you are, or have been, registered or licensed in in any profession, have you been subject to: conditions on your registration/licence Yes conditions on your annual licence/practising certificate Yes refusal by a registering or licensing authority to issue a practising certificate Yes If you replied yes to any of the above, write to the SWRB Registrar explaining the circumstances and enclose in a sealed envelope with your application. 9. CURRICULUM VITAE See Guide te 11 Attach copy of curriculum vitae (detailing work and education history for the past 10 years) 4

6 10. FIT AND PROPER CRITERIA The SWRB is required to determine whether you are fit to be recognised to practise social work in New Zealand. Police check See Guide te 12 Attach a current Police Certificates from any overseas countries you have lived in for twelve months or more in the last ten years whether on one or more visit Convictions / Court orders See Guide te 13 Have you ever been convicted by any court, of any offence or are you currently under investigation for any offence? Yes write to the SWRB Registrar explaining the circumstances and enclose in a sealed envelope with your application Are you currently or have you ever been a respondent for a protection order, restraining order, or trespass order? Yes write to the SWRB Registrar explaining the circumstances and enclose in a sealed envelope with your application Mental, physical or social condition See Guide te 14 Are you affected by a mental, physical or social condition which may affect your ability to perform professional social work? Yes write to the SWRB Registrar and include any relevant medical reports or evidence from a practitioner as appropriate. Enclose in a sealed envelope with your application. 11. APPLICATION FEE AND PAYMENT See Guide te 15 Application fee is $368 New Zealand Dollars CREDIT CARD PAYMENT OVERSEAS BASED AND NEW ZEALAND BASED APPLICANTS Please debit my MasterCard Visa Card number: Expiry: / Name on card: Signature: Date: FOR NEW ZEALAND BASED APPLICANTS ONLY I enclose a cheque / Bank cheque made payable to: The Social Workers Registration Board i have paid by direct credit / internet banking with my initials and surname as the reference and NEWAPP as the code. (Please note that not including the reference and code may delay your application being processed.) Social Workers Registration Board Bank Account Number: ANZ Bank: Payment Date: 5

7 12. DECLARATION AND SIGNATURE See Guide te 16 I hereby certify that I am the person who is applying for registration as a social worker in New Zealand, that I am the person named in the above application, and that the information I have given above is true and correct. I understand that the information that I have provided is to be used by the Social Workers Registration Board and its agents for the purposes of considering my application and may be disclosed to agents of the Board for these purposes. I intend to live and practise social work in New Zealand. I understand that the Board is authorised to obtain further information from me or any person or organisation concerning this application under the Social Workers Registration Act 2003 and consent to the collection of such information by the Board or its agents. I further understand that although the provision of any information by me is voluntary, if I refuse to provide any information this may affect the Board s consideration of my application. I understand that I am entitled to access the information held by the Board regarding this application by a request in writing to the SWRB Registrar, unless confidentiality has been requested by the provider of any of this information and that I may request correction of any information which is not correct. I understand that confirmation of registration from the Social Workers Registration Board is necessary before I am permitted to refer to myself as a Registered Social Worker in New Zealand. I understand that before I am permitted to commence practice as a Registered Social Worker in New Zealand I must be granted an Annual Practising Certificate from the Social Workers Registration Board. I undertake to inform myself on my responsibilities as a Registered Social Worker in New Zealand and agree to abide by the established Code of Conduct for Registered Social Workers in New Zealand. Applicant s signature: Date: Completed your application? What happens next? Thank you for your application for registration as a social worker in New Zealand. Once we have received your application you will be sent an acknowledgment. If aspects of your application are incomplete, or documents are missing, we will contact you to request the relevant information. When your application is complete and assessed it will be considered at the next scheduled Board Meeting. The Board meets monthly to approve registrations. If not already in New Zealand, when you arrive notify the Board of your contact details. All Registered Social Workers practising in New Zealand are required by the legislation to hold a current Annual Practising Certificate. The SWRB financial year is 1 July 30 June. Your application fee includes the Annual Practising Certificate fee through to the end of the financial year in which you apply. 6

8 check list IMPORTANT NOTE: PLEASE CHECK THAT YOU HAVE ATTACHED ALL THE FOLLOWING RELEVANT DOCUMENTS WITH YOUR APPLICATION. PLEASE READ THE ACCOMPANYING GUIDE NOTES BEFORE YOU COMPLETE THIS FORM, THEN REFER TO THE RELEVANT NOTE AS YOU WORK THROUGH EACH PART. PLEASE DO NOT SEND ORIGINALS; SEND CERTIFIED PHOTOCOPIES ONLY One passport-sized photograph, with your name on the back and signed by the person who fills in the declaration of your application Certified copy of your birth certificate Certified evidence of a change of name (if applicable) Certified copy of the relevant identification page(s) of your passport Certified copy of your primary social work qualification (and certified translation if not in English) Certified copy of your official academic transcript (and certified translation if not in English) Copy of SWRB n-binding Assessment Outcome Copies of registration certificate(s)/licence certificate(s), if you have any current or previous social work registration(s) and/or licence(s) in other countries Overseas competence assessment application Police Certificates from any relevant overseas countries Curriculum vitae Application fee PLEASE NOTE THAT THE SWRB CANNOT RETURN ANY ACCOMPANYING DOCUMENTATION Please mail your complete application and relevant documents to: SOCIAL WORKERS REGISTRATION BOARD PO Box 3452 Wellington Central Wellington VIII SWRB APPLICATION FORM

9 Confidential Reference Request Dear Referee Applicant name: has applied for registration as a Social Worker in New Zealand. Date of birth: DD/MM/YYYY Under the Social Workers Registration Act 2003 the Social Workers Registration Board has to satisfy itself that an applicant is a fit and proper person to be registered as a social worker. To assist the Board would you kindly write a character reference for the applicant covering the following matters: How long and in what circumstances have you known the applicant? Your knowledge of their social work practice. What reasons relating to character, integrity, reliability and diligence, in your opinion, make the applicant suitable for registration as a social worker? Whether there are any factors known to you that would or might be considered to make the applicant unsuitable for registration as a Registered Social Worker. To your knowledge, whether the applicant has ever been convicted of an offence. Please include your full contact details. It is Social Workers Registration Board policy to accept only original, signed and dated references. It would be appreciated if you would please quote the applicant s full name and date of birth (as per the top of this form) and then forward the completed original reference to: SOCIAL WORKERS REGISTRATION BOARD PO Box 3452 Wellington 6140 New Zealand Thank you for your assistance. Registrar

10 Guide notes IMPORTANT NOTE: PLEASE READ THESE NOTES BEFORE COMPLETING THE APPLICATION FORM, THEN REFER TO THE RELEVANT NOTE AS YOU WORK THROUGH EACH PART. Certification of a document refers to a copy of an original document that has been certified as a true copy of the original by a legal practitioner or person legally authorised to notarise or certify the authenticity of copies of documents in either New Zealand or an applicant s country of origin. Each page of the document(s) must be signed and dated. All documents not in English must be officially translated unless otherwise specified. A certified copy of both the original and English translation of each document must be included with the application form. Guide te 1 IDENTIFICATION Please attach one passport-sized photograph of yourself with your name on the back. If your name has changed from that shown on your birth certificate, please attach certified copies of any relevant name change documents. Guide te 2 DECLARATION Please get a Solicitor, Court Registrar, Justice of the Peace, or Gazetted Officer to complete and sign this part of your application. This confirms your identity. IMPORTANT NOTE: The person who signs this part of your application must also certify the copy of your passport. Guide te 3 ADDRESSES Please supply your home, mailing, and New Zealand address if available. Your home address will be held in confidence by the Social Workers Registration Board, and will not be published in the Social Workers Register, pursuant to Section 123 and Section 135 of the Social Workers Registration Act Guide te 4 QUALIFICATIONS Part A Overseas social work qualifications Must be equivalent to a recognised New Zealand qualification. Please provide information and supporting certified documentation for all social work qualifications to be considered in this application. The documentation required includes the following: A certified copy of your primary social work qualification (and certified translation if not in English). This means all relevant academic degree/diploma certificates conferred by an accrediting social work education or training authority. The document should state the name of the qualification, the name of the conferring or accrediting institution and the date of conferralor award. A certified copy of your official academic transcript for your qualification (and certified translation if not in English). A transcript is an official academic document issued by the institution granting the qualification. It lists the subjects taken, the marks obtained in each subject, the year the subjects were taken and the nature and date of any qualification conferred. A copy of the SWRB n-binding Assessment Outcome (if undertaken). Guide te 5 QUALIFICATIONS Part B Fieldwork/Practicum Professional social work qualifications require a certain number of days of fieldwork. Fieldwork normally occurs over 2 or 3 placements. Please describe the nature of your fieldwork and the length of time spent on each placement. Guide te 6 COMPETENCE IN ENGLISH If you are from a country where the medium of instruction and assessment in secondary schooling and professional education is not English, you must undertake an International English Language Testing Systems (IELTS ) test at the ACADEMIC level and achieve an overall score of at least 7.0, with a minimum of 7.0 in each band. The test may be taken via the English department of most universities. Please ask the testing authority to send your IELTS results direct to the SWRB. Based on the registration and competence applications the Board may request a further English language test

11 Guide te 7 CURRENT OVERSEAS LICENCE AND/OR REGISTRATION IN SOCIAL WORK Please attach certified copies of your most recent overseas social work registration(s) and/or licence(s). Guide te 8 COMPETENCE To apply for registration as a social worker in New Zealand you must include with this application an SWRB paper-based overseas competence assessment application Guide te 9 CONFIRMATION OF CHARACTER The SWRB requires a reference from a person not related to you, nor living in the same household as you, to attest to your character. They should be: your current employer, or someone for whom you have provided contracted services as a social worker, or your current supervisor AND have known you for at least six months. Give your referee a copy of the enclosed Confidential Reference Request information sheet. The referee must post the reference directly to the SWRB office. Guide te 10 Professional disciplinary proceedings This section relates to your fitness to be registered to practise social work in New Zealand. It enables the Board to determine whether you are currently, or have previously been, subject to any professional disciplinary actions within any profession (for example, social worker, nurse, lawyer, psychologist, etc). Guide te 11 CURRICULUM VITAE Please ensure your curriculum vitae (CV) includes details of work and education history for the past 10 years. Please explain any gaps in your CV (for example, parental leave, travel), and include the following information for all social work positions you have held: dates of employment name of agency nature of work undertaken by agency duties undertaken in position whether full or part-time and hours per week. Guide te 12 Police check You must provide a police certificate from any country you have lived in for twelve months or more in the last ten years whether on one or more visits. Please ensure that the police certificate covers the period you were in those countries. Guide te 13 Convictions / Court orders Please provide details of: any court convictions you may have, in any country, of any offence any offences you are currently under investigation for any protection orders, restraining orders, or trespass orders you are currently, or have been, a respondent for. Guide te 14 Mental, physical or social condition Please describe any medical, psychological, psychiatric or addiction (drugs or alcohol) disorders, physical deterioration due to injury, disease, degeneration, or social condition which may affect your ability to perform professional social work. Enclose any relevant medical reports or evidence from practitioners as appropriate. Guide te 15 APPLICATION FEE AND PAYMENT Overseas based applicants must pay using either MasterCard or Visa. Guide te 16 DECLARATION AND SIGNATURE Please sign and date your completed form to confirm that you have supplied true and correct information, and read and understood all instructions. Forms that are not signed and dated will not be accepted by the SWRB and will be returned. IMPORTANT NOTE: YOU MAY ONLY APPLY FOR REGISTRATION IF YOU INTEND TO LIVE OR ARE CURRENTLY LIVING IN NEW ZEALAND AND INTEND TO PRACTISE SOCIAL WORK.

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