Register

To apply for positions in Australia or overseas, please complete this form and submit to the AMA (WA) for consideration.

Personal Details
Full Name:
Address:
Email Address:
Date of Birth:
Home Phone:
Mobile Phone:
Work Phone:
Please provide your full mailing address, and include international area codes on your phone numbers.

Australian/Overseas
Are you a permanent resident/citizen of Australia?	Yes No
If no, are you applying from overseas?	Yes No
If applying from overseas, please visit our Interested in Working in Australia page instead.

Qualifications
Enrolled Nurse	Mental Health Nurse
Registered Nurse	Child/Community Health Nurse
Registered Midwife	Occupational Health and Safety Nurse

Skills
Medical	Surgical	Palliative Care/Oncology
Geriatrics	Intensive Care Unit	Accident/Emergency
Community Nursing	Remote Area Nursing	Ventilator Competent
IV Cannulation	Audiometry	Nursing Administration
Paediatrics	Theatre	Practice Nurse/GP Specialist
Child Health Nurse	ECG's	Phlebotomy/Venepuncture
Other Relevant Skills:
Please tick areas in which current (within the past 2 years) competent skills exist and add any others which you feel might be important to your application.

Work Required
Work Type:	Permanent Temporary Full Time Part Time
Special Times:	Evenings Weekends
Practice Type:	GP Specialist Hospital
Date available to start work:
Number of hours per week:
Preferred location:
Are you prepared to work shifts?	Yes No
Minimum salary expectations:
Driver's Licence?	Yes No
Own Car?	Yes No

Duty of Care Statement

In order for AMA Recruit to assess an applicant's suitability regarding employment and ensure all areas of duty of care are covered, please provide as much detail as possible in relation to: Medical History, Workers Compensation and Criminal Record.

Privacy Statement

AMA Recruit and associated entities primary purpose of collecting information you supply on this form is to process your employment application and conduct placement and training related activities. In providing your details you consent to your personal details being used in the manner indicated.

Medical History
Have you ever suffered from:
Skin Condition (eg. Dermatitis)	Hernia	Epilepsy
Problems/Injury to Back or Neck	Diabetes	Nervous Disorder (incl Depression)
Injury to Shoulders, Hips or Limbs	Asthma	Repetitive Strain Injury (RSI)
Do you have a disability, injury or physical ailment that may prevent you from undertaking the following duties:
Restraining an object or person	Stretching	Pushing/Pulling
Standing for long periods of time	Lowering	Carrying
Working with hazardous chemicals	Holding	Moving
If Yes to any of the above, please provide details:
Please note: Failure to disclose a pre-existing disability may jeopardise your rights to Worker's Compensation if a pre-existing disability is aggravated at work (Section 79 of the Worker's Compensation and Rehabilitation Act 1981).

Worker's Compensation
Have you ever had a Worker's Compensation claim or intend to lodge a claim in the future regarding a previous injury or accident?
Yes No
If Yes, please give details of the claim including employer, injury and dates.
Details of Claim:

Criminal Record
Have you ever been convicted of a criminal offence or are you currently the subject of a charge pending before any court?
Yes No
Are you prepared to produce a Criminal Clearance Certificate (Police Clearance) as a condition of being offered employment?
Yes No

Checklist
Curriculum Vitae:	Must include 2 references
Spam Prevention:	Copy the text shown

Please ensure all above information is correct prior to submitting.