Searson Buck

Nursing & Health Information Form

Please upload your current resume

Choose file

Upload a Profile Picture

Choose file

Personal Information

* Salutation

* First Name

Middle Name

* Last Name

Preferred Name

* Date of Birth

Gender

Contact Information

* Email

* Mobile Phone

Home Phone

Address Details

Address

* City/Suburb

* State

* Postal Code

* Country

Emergency Contact Details

Emergency Contact Name

Relationship to you

Contact Number

Work Preference & Travel

How will you travel to work?

How far are you willing to travel (specify mins/kms)?

Facilities & departments you would prefer to work at?

Would you be interested in Rural & Remote work?

* Please select your roles/categories

* Please select any specialties or skills that best represent your experience over the past 1–2 years:

What is your preferred work type?

Availability

Interested Work Types

Do you have a Notice Period?

How many weeks is required?

Personal Identification

To assist us to process your application more efficiently and have you working with us quicker, in a role you love - we ask you to provide evidence that will satisfy a 100 point Identification Check:

* What is your Australian Residency Status?

If you are NOT a Citizen or Permanent Resident of Australia please enter your visa expiry date.

Passport Issuing Country

Visa Number

Identification Document #1

Choose file

Expiration Date

Document Type

Identification Document #2

Choose file

Expiration Date

Document Type

Registration & Certificates

Searson Buck and our clients require certain certifications, professional development records, or registrations before you can begin practice. please upload any relevant certificates or training records in this section. As a professional nurse, you are expected to keep your training up to date, and you may be asked to provide updated records when required.

Mandatory Nurse Documentation

* AHPRA RegistratioN

Choose file

* National Police Check (not older than 12 months) or evidence of application

Choose file

* Working with Vulnerable People or evidence of application

Choose file

A medication endorsement is a professional qualification that certifies a healthcare provider to have additional expertise in prescribing and administering specific types of scheduled medications

Medication Endorsement Certificate

Choose file

Support Worker Essentials

Certificate III

Choose file

Optional entry courses including- not limited to:

BLS Theory

Upload #1

Choose file

Expiration Date

Document Type

ALS/PALS (Acute RN/EN)

Upload #2

Choose file

Expiration Date

Document Type

CPR Practical Assessment

Upload #3

Choose file

Expiration Date

Document Type

Candidate Declaration

* Do you have any limitations to practice, or Have you ever been, or are you currently suspended from duty with any employer, organisation, agency or by the Professional Body?

yes

If yes, please add additional details here

* Are you aware of any professional enquiries undertaken following allegations made against you in Australia or abroad, which may have a bearing on your suitability for assignments with us?

yes

If yes, please add additional details herE

* Do you have any health issues which may affect the way you undertake assigned work activities, or which may prevent you from carrying out your duties on site?

Yes

If yes, please add additional information here

* I authorise Searson Buck Group to confidentially disclose information held about me to organisations as outlined in the Privacy Policy as I am advised of specific or potential opportunities.

* I declare that the information supplied by me is to the best of my knowledge, true, accurate and complete in all respects. I acknowledge that I will not hold Searson Buck Group responsible for any omission or misstatements, which I have made in the information provided. I understand that if I do not provide information or information provided is insufficient or inaccurate, Searson Buck Group and its related entities will be limited in its ability to provide its services, or enable full consideration for employment opportunities with client organisations. I also agree to having this information verified by relevant external organisations as required.

* To allow a Searson Buck Group representative to contact me outside of normal business hours to offer, confirm or cancel shifts.

* I confirm that I have read and that I accept Searson Buck's Privacy Statement