How to apply

Forward this application with the following:

•Coveringletter

•Clinical placementevaluations

•Interim Academicrecord

•Current police check(copy)

To 1+ Learning & Development Coordinator

Calvary North Adelaide Hospital, 89 Stangways Terrace, North Adelaide SA 5006

Please number from 1 to 4, your preference for CHCA hospital site:

Calvary Wakefield Hospital, 300 Wakefield Street, Adelaide 5000

CalvaryNorthAdelaideHospital,89StangwaysTerrace,NorthAdelaide5006

CalvaryRehabilitationHospital,18NorthEastRoad,Walkerville5081

CalvaryCentralDistrictsHospital,25JarvisRoad,ElizabethVale5112

APPLICATIONS CLOSE 12th AUGUST 2016

oneplus Application Form

Surname:First Names: Address:


Phone:(home)(mobile)(work)

AreyoulegallyentitledtoworkinAustralia?YesNo(give details asbelow)

Please indicate: Citizen Permanent Resident Sponsorship Visa Required Work Permit/Expiry Date

If successful with this application what date could you commence employment?

Asaparticipantinthegraduateprogramyouwillberequiredtoworkshiftworki.e.morning,evening,nightsandweekends
throughoutthe12monthcontract.Isthereanyreasonthatyouwouldnotbeabletoundertakethisrequirement?

Yes (givedetailsasbelow)No

Details:


How Did You Hear About Us?

Weareinterestedtoknowhowyoufirstbecameawareofourgraduateprogram:University promotionaltalk

ClinicalPlacementWebsite Relativeofapatient

Feedback from other graduates / students

Other:

Education

Tertiary Qualifications (Academic transcripts will need to be provided at interview)

Course Title / Commencement Date / Completion Date / Grade Average / Institution
Eg: Bachelor of Science (Nursing) / Jan 02 / Dec 04 / P1 / Uni SA


Employment History

Please provide your employment history (include any full-time, part-time or casual work, nursing related or otherwise).

Employment / Position / Duration / Hours per week
E.g. St Peter’s Nursing Home / Nursing Assistant / Jan 2002 – Present / Approx 16 hours/wk


Referees

Please give the names, telephone number and email address (if possible) of two recent work referees who have supervised you e.g a clinical facilitator from a recent practicum placement and a manager from part time employment.

Name:Title: Employer: Telephone Number: EmailAddress:

Hastherefereegivenpermissionforcontact?YesNo

Name:Title: Employer: Telephone Number: EmailAddress:

Hastherefereegivenpermissionforcontact?YesNo

Employee Referee Consent

DoyouconsenttoCalvaryHealthCareAdelaidediscussingtheinformationcontainedinyourapplication withtherefereeslisted?

YesNo

N.B. Referees will only be contacted after interview unless otherwise advised.


Personal and Professional Interests

Some of my personal and professional interests/activities include:




Please complete the following statements -

My Short Term Career Goals are:




My Long Term Career Goals are:




I have shown commitment personally and professionally by:




I would like to be considered for a position on the oneplus because:





Disclosure of an illness will not preclude you from consideration for employment for the position sought.

Calvary Health Care Adelaide is committed to providing a safe work environment for all staff. The Work Health and Safety Act 2012 obligates Employers to ensure the workplace health and safety of each employee at work.

In an effort to assist us to meet these obligations you are requested to complete the following questionnaire. The information provided on this form will assist us in placing strategies to reduce risk of infection or injuries to our staff.

Please note: The information that you disclose on this form is for the internal use of the hospital only and will be kept strictly confidential.

Do you suffer or have ever suffered from the following medical conditions:

Disease/Conditions / Yes / No / Unsure / Details/Treatments/Comments
Allergies e.g. latex, chemicals, medications
Dermatitis
Asthma

Do you suffer or have you ever suffered from the following musculoskeletal problems
(i.e. sprains/strains)

Body Location / Yes / No / Unsure / Details/Treatments/Comments
Back
Neck
Shoulders/Arms
Hips/Legs
Ankles
Have you ever been immunised for Hepatitis B? / Yes / No / If yes,what year?
If yes, did you achieve an immune response / Yes / No
Tuberculosis: Have you had a mantoux test? / Yes / No / If yes,what year?
Have you ever had Chicken Pox? / Yes / No
Have you ever had an MMR
(Measles, Mumps, Rubella) immunisation? / Yes / No
Have you had Tetanus immunisation? / Yes / No
Have you had Pertussis immunisation? / Yes / No
Have you had Poliomyelitis immunisation? / Yes / No
Isthereanyreasonormedicalconditionthatmayimpair your ability to perform the job you are applying for?
(working 24 hour / 7 day week roster) / Yes / No

If yes, please providedetails:


You may be asked to attend a function capacity test as part of the recruitment process.

Do you agree to this request?YesNo


IdeclarethattheinformationIhavegivenistrueandcorrectandIhavenotwithheldanyrelevantinformationyou shouldbeawareofwhenconsideringwhethertoemployme.Iunderstandthatyoucouldterminatemyemploymentif youfindthatIhavegivenyouuntruthful,inaccurateormisleadinginformation.

Ifrequired,Iagreetoamedicalexaminationatanytimeduringmyemployment.Amedicalofficerwillbenominated byCalvaryHealthCareAdelaide.Iunderstandthatthiswillbedoneinthebestinterestsofmyhealthandthesafety ofmyworkcolleaguesandpatients.

IauthoriseCalvaryHealthCareAdelaidetoobtainanyinformationanddocumentsrelevanttoanyinjury,illnessor medicalconditionImaysustainduringtheperiodofmyemploymentwithCalvaryHealthCareAdelaidewhichmay beinthepossessionofthefollowing:

1.Thisoranotherhospital;or

2.Any ambulance service;or

3.Adoctor,provideroftreatmentorrehabilitationserviceorpersonqualifiedtoassesscognitive,functional orvocationalcapacity;or

4.Apreviousemployer;or

5.InsurersthatcarryonthebusinessofprovidingWorkersCompensationInsurance,CompulsoryThirdPartyInsurance, personalaccidentorillnessinsurance,orinsuranceagainstthelossofincomethroughdisability,superannuation fundsoranyothertypeofinsurance;or

6.Adepartment,agencyorinstrumentalityoftheCommonwealthortheState.

IunderstandthatifIamemployedthisapplicationandmyresumewillbecomeapermanentdocumentofmypersonnelfile.
IfIamnotsuccessfulinobtainingemploymentthisdocumentwillbestoredanddestroyedaftersixmonths.

I sign this declaration to confirm I have read and agree with the above conditions.

Signature:Date: