Melbourne Nursing Agency Registration

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Qualification

Registered Nurse

Division 1

Division 2

Personal Care Worker (qualified)

Nurse Assistant

Theatre Technician

Pathology Collector

Qualification Obtained at

University/training institution

Year of completion of course

Post Graduate qualifications

When did you last attend an educational update on

Infection control

Manual Handling

Safe Administration of medicine

CPR

Personal Details

Full Name

Date of Birth

Address

Street

Suburb

Postcode

Country

Contact

Telephone

Mobile Telephone

Fax

Competancies

Please mark the areas in which you are competant

General Nursing
Accident & Emergency
Cardiothoracic
Surgical
Neurosurgical
Renal
Dialysis
Orthopaedics
Plastic surgery
Oncology
Medical
Vascular
Ear, nose and throat
Theatre
Recovery
Anaesthetics
ICU/ ventilator competant
ICU non-ventilator competant
High dependency
Day surgery
Aged Care Nursing
Hostel
Nursing Home
Community home care
Standards of care
Psycho-geriatrics
Dementia specific units

Paediatric Nursing
A & E
NICU general surgical
NICU general medical
Psychiatric nursing
Acute
Adolescent
Psycho-geriatric
Forensic
Community Assessment
Correctional health service
Midwifery
Labour ward
Antenatal
Post natal
Neonatal Intensive Care
Special Care Nursery
Gynecology
Education
Clinical teaching
Clinical supervision
Classroom/laboratory teaching
Specialist areas eg Infection control
Management
ADON
DON
Clinical supervisor

Other

Preferences

Please Mark your preference for the following

Short term placements

Extended placements (3 months+)

Permanent placement

Do you prefer to work in

Acute hospitals

Nursing homes

Community settings

Other

Availability

When are you available to start work?

Do you work for another agency?

How did you find out about Melbourne Nursing Agency?

Thank you for completing the form, please press the submit button and you will see a confirmation screen appear. We will be in contact with you soon to organize an interview and to provide you with some more information about us.

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