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If you are interested in looking for employment in New Zealand in the health field, you can register on line. Please complete the details below and we will contact you with any available positions in your chosen field. We look forward to having your name on our database.

Personal Details

First NameMiddle NameSurnameDate of Birth(We are asking you this question to be able to provide advice on visa issues. You do not have to provide this information)

Area of Work / Profession

Please upload an up to date CV (not PDF)

Current Address

StreetRegion / State / DistrictCityPost CodeCountryPhoneFaxEmailMobile

Alternative Contact

(Someone who always knows where you are and can be contacted in case of emergencies)

NameRelationship to youAddressPost CodeCountryPhoneFaxEmailMobile

Qualifications

	University/College/School	Qualification Obtained	Date Qualified	Course Length
1
2
3
4
5

Professional Information

Professional Associations of which I am a Member Licences / registrations held I have NZ registration

Yes No

If yes, Registration BoardMy registration number is: Please attach proof of your status by way of certified copy I have applied for NZ registration

Yes No

Date of ApplicationMy reference number is:

Visas and Permits

Nationality(Please note if you have more than 1 nationality) My Passport expires on: Work Visa

Yes No

Visitor Visa

Yes No

Working Holiday Visa

Yes No

Residency

Yes No

Citizenship (NZ or Australian)

Yes No

I have no visa or permit

Yes No

I will be travelling on my own

Yes No

I will be travelling with family

Yes No

I will be travelling with partner

Yes No

My travel companion(s) will look for employment in (please note their profession):

Work Details

If there is a suitable position I can start work on (date): Are you looking for permanent employment?

Yes No

If not, what length of contract are you looking for?Clinical areas I would like to work in: Geographical areas preferred (please let us know if you have connections to a particular part of the country):

Legal Information

Have you been convicted of a criminal offence?

Yes No

Are you currently involved in a process that may result in a criminal conviction?

Yes No

If your answer is yes, a prospective employer may ask you to provide further details. Have you ever been subject to a finding by a professional body or tribunal of professional misconduct?

Yes No

If yes, please provide details of such finding/s

Drivers Licence

Do you have a Drivers Licence?

Yes No

If Yes, is it:

Full Partial

Expiry dateAny comments?(please make us aware of any restrictions)

Other Information

Have you tried to obtain employment in New Zealand previously?

Yes No

How did you hear about us?

Partner's Details

Please include if your partner would like to be updated on possible positions. First NameSurnameCountry(ies) of CitizenshipPhoneFaxEmailMobileArea of Work / Profession

Declaration

I declare that the information I have given is correct and I understand any information falsely given may lead to disqualification, or if appointed, to termination of employment.

I agree and undertake to inform Health ProfessionalNZ of any material changes to my details as provided in the application form.

I authorise Health ProfessionalNZ to hold the information in this application form and my curriculum vitae for the purposes of discussing employment opportunities with prospective employers.

I understand that Health ProfessionalNZ will endeavour to keep me informed as to whom the personal information they hold about me has been disclosed to.

Note to Applicants
The New Zealand Government requires that applications be considered without regard to gender, age, national origin, religious or political belief, and sexual orientation.

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