1.Personal Details - (Please Complete All Details Electronically)

APPLICATION FORM GRADUATE ENROLLED NURSE (EN)

2017 ACT Health EN Transition to Practice Program (TTPP)

1.Personal Details - (Please complete all details electronically)

Surname:
First Name:
Residential Address:
State/Territory:
Email address (not university address):
Telephone: (Home) (Mobile)

Eligibility – (Please complete all details electronically)

I have completed/will complete my Diploma in Nursing in 2016 Yes  No 
Applicants need to have completed or will complete studies between November 2015 and June 2017
Are you currently registered: Yes  No 
If no, when will you be eligible to register with the Australian Health Practitioner Regulation Agency (AHPRA)?Please note this must occur prior to program commencement.
Are you an Australian Citizen / Permanent Resident? Yes  No 
If no, do you hold a current valid visa that allows you to work Yes  No 
In Australia (this includes New Zealand citizens): Details: ......
You need to hold the relevant work visa at the time of application to be eligible to apply
3. Commencement Date – (Please select your preferred intake date)
February 2017
4.Referee Details– (Please attach two professional written referee reports using TTPP 2016 template)
Name of referee 1: / Name of referee 2:
Organisation: / Organisation:
Position Held: / Position Held:
Email: / Email:
Telephone: (Business Hours) / Telephone: (Business Hours)

5. Duty Statement – Enrolled Nurse

1. Provides competent and safe patient care within an ethical, professional and quality framework and practices in accordance with the relevant legislation. Integrates organisational policy and guidelines with professional standards.
2. Adheres to the scope of practice of aEnrolled Nurse – Level 1. Aware of differences in accountability and responsibility between EN and RN and undertakes role according to the appropriate standard.
3. Considers and advocates for individuals and/or groups and their rights for nursing care within the organisational and management structure.
4. Be responsible for completing all professional development requirements and demonstrating competency as a beginning registered nurse within the graduate nurse program in the required timeframes.
5. Practices in a way that acknowledges the dignity, culture, values, beliefs and rights of individuals and/or groups. Adhere to safe practice and relevant legislation.

6. Selection Criteria(please complete electronically)

Please read the selection criteria carefully and type your response on page 3 and 4

In no more than 2 pages (half a page per question) answer each selection criterion.
Provide an example of how you have demonstrated each criterion in your nursing practice to deliver quality patient care.

How will your clinical practice reflect commitment to Diversity/Cultural Competence?
Why is clinical handover important and how will you ensure that your handover is effective?
Discuss how you will ensure workplace safety rules and regulations are adhered to?
Why is critical thinking important in your role as an enrolled nurse?

Please complete this electronically as part of the Application Form usingArial 11 font, single spacing and standard margins.

Note: Please keep within the recommended two page limit (half page per question)

Selection Criteria .1.

Selection Criteria .2.

Selection Criteria .3.

Selection Criteria .4.

7. Selection Process

Employment decisions will be based on:

Completed application form inclusive of the two page selection criteria(4 questions)
Referee reports (Professional) x 2 – Required: 1 x clinical and 1 x paid employment or 2 x clinical
Satisfactory TAFE/CIT transcript - Academic history to date
If not anAustralian citizen or permanent resident – holds a current work rights VISA for Australia
Short listing will take place from the above submitted documentation. Short listed applicants will be invited to attend an Interview and Assessment Centre on either the 29th or 30thSeptember 2016. At this time all elements of the application process will be considered including performance at Interview and assessment at the Assessment Centre.

8.Final checklist – (Please ensure you have attached all documents)

Curriculum Vitae attached

TAFE/CIT transcript attached

Read and Acknowledged Duty Statement of a Enrolled Nurse (page 2)

Selection Criteria– 4 criterion (no more than 2 pages, Arial 11 font, single spacing) attached

I am an AustralianCitizen/Permanent Residentor

I hold a valid, current VISA (such as a 485) that allows me to work in Australia

Two written referee reports using the ACT Health TTPP 2016 referee template (attached)

I have completed all sections of the application form and acknowledge the information provided is true and correct

eSignature of applicant: ______Date: ______

Closing date for February2017intake applications: Close of Business1st September 2016

Please note that incomplete or late applications will not be considered.

If you have any questions please contact:

EN Coordinator Maxine Jordan:
or phone (02) 62443382;

EN Clinical Development Nurses:

or phone (02) 6244 3360.

/ REFEREE REPORT
EN Transition to Practice Program 2017
Applicant:
Referee name/title /work location: / Phone
Fax
Relationship to Applicant: / Period of working relationship:

Suitability against the selection criteria (Make either comments or a Rating, or both)

Criterion / Please make comment about the applicant in relation to each criteria below using the rating scale (this criteria is generic to both clinical or non clinical, paid employment) / Rating as per attached scale
SC1 / Well developed communication and interpersonal skills / ( )1211109876543210
SC2 / Responsible, reliable and adheres to policy and regulations / ( )1211109876543210
SC3 / Commitment to customer service, equity and diversity / ( )1211109876543210
SC4 / Commitment to learning and strives for best practice / ( )1211109876543210

General Comments (eg, Attendance, general behaviour and attitude to work, quality of work and work skills, strengths, weaknesses, and areas for development.)

Is there anything else we need to know about the candidate which is relevant to our selection processes?

Have you provided a copy of this reference to the applicant?Yes No

Signature
Name of referee
Date:
/ REFEREE REPORT
EN Transition to Practice Program 2017
Applicant:
Referee name/title /work location: / Phone
Fax
Relationship to Applicant: / Period of working relationship:

Suitability against the selection criteria (Make either comments or a Rating, or both)

General Comments (eg, Attendance, general behaviour and attitude to work, quality of work and work skills, strengths, weaknesses, and areas for development.)

Is there anything else we need to know about the candidate which is relevant to our selection processes?

Have you provided a copy of this reference to the applicant?Yes No

Signature
Signature of referee
Date:

10. Referee Report – Rating Scale

The assessment ratings as detailed below should be used by the Selection Advisory Committee to measure the performance of the applicant’s skills and abilities in respect of each of the selection criterion, as demonstrated in the job application, interview and Referee reports.

The alphabetical ratings may be adjusted (i.e. C-FC) in cases where the given rating does not best describe the assessment, and/or to assist in differentiating the performance of two or more applicants. (Assessments are to be recorded on the Selection Report Form)

This assessment rating scale is to be used for the entire process including short-listing, any assessment method including interviews, individuals and comparative assessments of applicants, and Referee reports.

ACT Health –Transition to Practice Program for Graduate Enrolled Nurses - Application Form 2016 intake 20171/9