Enrolled Nurses (HCNA 1)

Home Care Nurses Australia is collecting personal information from you as part of the recruitment and selection process.  Home Care Nurses Australia recognises the important of privacy and is committed to ensuring the privacy of your personal information collected and/or received by us.

1. Yes I agree to the privacy statement*

1. Title* Mr Mrs Ms Miss Dr Other
2. First name*
3. Last name*

1. E-mail*
2. Phone*

   Digits only or add + for international numbers

1. Street*
2. Street Cont.
3. City, Town or Suburb*
4. Postcode or Zipcode*
5. Country*Please choose... AFGHANISTAN ALBANIA ALGERIA AMERICAN SAMOA ANDORRA ANGOLA ANGUILLA ANTIGUA AND BARBUDA ARGENTINA ARMENIA ARUBA AUSTRALIA AUSTRIA AZERBAIJAN BAHAMAS BAHRAIN BANGLADESH BARBADOS BELARUS BELGIUM BELIZE BENIN BERMUDA BHUTAN BOLIVIA BOSNIA AND HERZEGOVINA BOTSWANA BRAZIL BRUNEI DARUSSALAM BULGARIA BURKINA FASO BURUNDI CAMBODIA CAMEROON CANADA CAPE VERDE CAYMAN ISLANDS CENTRAL AFRICAN REPUBLIC CHAD CHILE CHINA COLOMBIA COMOROS CONGO CONGO, THE DEMOCRATIC REPUBLIC OF THE COOK ISLANDS COSTA RICA COTE D'IVOIRE CROATIA CUBA CYPRUS CZECH REPUBLIC DENMARK DJIBOUTI DOMINICA DOMINICAN REPUBLIC ECUADOR EGYPT EL SALVADOR EQUATORIAL GUINEA ERITREA ESTONIA ETHIOPIA FALKLAND ISLANDS (MALVINAS) FAROE ISLANDS FIJI FINLAND FRANCE FRENCH GUIANA FRENCH POLYNESIA GABON GAMBIA GEORGIA GERMANY GHANA GIBRALTAR GREECE GREENLAND GRENADA GUADELOUPE GUAM GUATEMALA GUINEA GUINEA-BISSAU GUYANA HAITI HOLY SEE (VATICAN CITY STATE) HONDURAS HONG KONG HUNGARY ICELAND INDIA INDONESIA IRAN, ISLAMIC REPUBLIC OF IRAQ IRELAND ISRAEL ITALY JAMAICA JAPAN JORDAN KAZAKHSTAN KENYA KIRIBATI KOREA, DEMOCRATIC PEOPLE'S REPUBLIC OF KOREA, REPUBLIC OF KUWAIT KYRGYZSTAN LAO PEOPLE'S DEMOCRATIC REPUBLIC LATVIA LEBANON LESOTHO LIBERIA LIBYAN ARAB JAMAHIRIYA LIECHTENSTEIN LITHUANIA LUXEMBOURG MACAO MACEDONIA, THE FORMER YUGOSLAV REPUBLIC OF MADAGASCAR MALAWI MALAYSIA MALDIVES MALI MALTA MARSHALL ISLANDS MARTINIQUE MAURITANIA MAURITIUS MEXICO MICRONESIA, FEDERATED STATES OF MOLDOVA, REPUBLIC OF MONACO MONGOLIA MONTSERRAT MOROCCO MOZAMBIQUE MYANMAR NAMIBIA NAURU NEPAL NETHERLANDS NETHERLANDS ANTILLES NEW CALEDONIA NEW ZEALAND NICARAGUA NIGER NIGERIA NIUE NORFOLK ISLAND NORTHERN MARIANA ISLANDS NORWAY OMAN PAKISTAN PALAU PANAMA PAPUA NEW GUINEA PARAGUAY PERU PHILIPPINES PITCAIRN POLAND PORTUGAL PUERTO RICO QATAR REUNION ROMANIA RUSSIAN FEDERATION RWANDA SAINT HELENA SAINT KITTS AND NEVIS SAINT LUCIA SAINT PIERRE AND MIQUELON SAINT VINCENT AND THE GRENADINES SAMOA SAN MARINO SAO TOME AND PRINCIPE SAUDI ARABIA SENEGAL SEYCHELLES SIERRA LEONE SINGAPORE SLOVAKIA SLOVENIA SOLOMON ISLANDS SOMALIA SOUTH AFRICA SPAIN SRI LANKA SUDAN SURINAME SVALBARD AND JAN MAYEN SWAZILAND SWEDEN SWITZERLAND SYRIAN ARAB REPUBLIC TAIWAN, PROVINCE OF CHINA TAJIKISTAN TANZANIA, UNITED REPUBLIC OF THAILAND TOGO TOKELAU TONGA TRINIDAD AND TOBAGO TUNISIA TURKEY TURKMENISTAN TURKS AND CAICOS ISLANDS TUVALU UGANDA UKRAINE UNITED ARAB EMIRATES UNITED KINGDOM UNITED STATES URUGUAY UZBEKISTAN VANUATU VENEZUELA VIET NAM VIRGIN ISLANDS, BRITISH VIRGIN ISLANDS, U.S. WALLIS AND FUTUNA WESTERN SAHARA YEMEN ZAMBIA ZIMBABWE INTERNATIONAL OTHER Unknown
6. State, Region or Province*Please choose...

1. LinkedIn URL

   (Please click on your profile and copy the URL from your profile page.)

1. You are required to be registered with AHPRA to progress your application.
   
   Are you currently registered with AHPRA?
   *

   1. Yes (Please upload your AHPRA Registration in the attachments section)
   2. No, but willing to acquire (AHPRA registration is required to work as a Nurse in Australia, we will email you the application details. Reach out once registered)
2. Do you have a Diploma of Nursing?*

   1. Yes - attach a copy when prompted
   2. No
3. You are required to be certified in Basic Life Support from a Registered Training Organisation (not in house hospital certificate) OR have both HTLAID009 CPR and HTLAID011 First Aid certifications. *

   1. Yes (Please upload current certification/s in the attachment section)
   2. No, but willing to acquire (We will email details about how to acquire certification/s. Reach out once you have certifications)
4. Have you completed an Infection Control certification?*

   1. Yes - please upload when prompted
   2. No
5. Do you have a current Yellow Card?*

   1. Yes - please upload when prompted
   2. No
6. Do you have a current Disability Worker Screening Card?*

   1. Yes - please upload when prompted
   2. No
7. How many years experience do you have as an Enrolled Nurse?*
8. Area of speciality
   
   (Select all that apply):*

   1. Medical
   2. Surgical
   3. Theatre
   4. Emergency
   5. Cardiac
   6. CCU
   7. Renal
   8. Orthopaedic
   9. Paediatric
   10. ICU
   11. Mental Health
   12. Maternity
   13. Other
9. Describe your level of skill in the following area – Wound Management and Assessment*

   1. Competent
   2. Not Competent
   3. Willing to learn
10. Describe your level of skill in the following area – SPC Management and Assessment*

    1. Competent
    2. Not Competent
    3. Willing to learn
11. Describe your level of skill in the following area – IDC Management and Assessment*

    1. Competent
    2. Not Competent
    3. Willing to learn
12. Describe your level of skill in the following area – EnteralFeeding and PEG/NGT management*

    1. Competent
    2. Not Competent
    3. Willing to learn
13. Describe your level of skill in the following area – Continence assessment *

    1. Competent
    2. Not Competent
    3. Willing to learn
14. Describe your level of skill in the following area – Diabetes management*

    1. Competent
    2. Not Competent
    3. Willing to learn
15. Describe your level of skill in the following area – Palliative/End Of Life Care*

    1. Competent
    2. Not Competent
    3. Willing to learn
16. Describe your level of skill in the following area – Recognising and responding to Clinical Deteriorating client*

    1. Competent
    2. Not Competent
    3. Willing to learn
17. Describe your level of skill in the following area – Pressure Area Care*

    1. Competent
    2. Not Competent
    3. Willing to learn
18. Describe your level of skill in the following area – Medication management and administration*

    1. Competent
    2. Not Competent
    3. Willing to learn
19. Describe your level of skill in the following area – Risk Assessments: Mobility, moving and handling; Environmental; Infection prevention; Skin integrity; Emotional and Social Wellbeing*

    1. Competent
    2. Not Competent
    3. Willing to learn
20. Please add any comments your would like to add about your clinical skill levels:
21. List your CURRENT vaccinations - please tick all that apply *

    1. Influenza
    2. Varicella
    3. ADT
    4. MMR
    5. Pneumococcal
    6. Hepatitis B
    7. Mantoux - Tuberculin Skin Test
22. Have you ever had any of the following illnesses or medical conditions? Depression, mental illness or nervous breakdown *

    1. Yes
    2. No
23. Have you ever had any of the following illnesses or medical conditions? Blackouts, fits or attacks of giddiness*

    1. Yes
    2. No
24. Have you ever had any of the following illnesses or medical conditions? Digestive or bowel disease*

    1. Yes
    2. No
25. Have you ever had any of the following illnesses or medical conditions? Bladder or kidney trouble *

    1. Yes
    2. No
26. Have you ever had any of the following illnesses or medical conditions? Varicose veins *

    1. Yes
    2. No
27. Have you ever had any of the following illnesses or medical condition? Back trouble *

    1. Yes
    2. No
28. Have you ever had any of the following illnesses or medical conditions? Typhoid or paratyphoid*

    1. Yes
    2. No
29. Have you ever had any of the following illnesses or medical conditions? Dermatitis or skin trouble *

    1. Yes
    2. No
30. Have you ever had any of the following illnesses or medical conditions? Rheumatism or arthritis*

    1. Yes
    2. No
31. Have you ever had any of the following illnesses or medical conditions? Diabetes, thyroid, or other gland trouble *

    1. Yes
    2. No
32. Have you ever had any of the following illnesses or medical conditions? Chest pain, heart condition or raised blood pressure *

    1. Yes
    2. No
33. Have you ever had any of the following illnesses or medical conditions? Tuberculosis, asthma, bronchitis or chest problems*

    1. Yes
    2. No
34. If you selected YES to any of the above questions, please give full details - dates, duration and outcome of the illness or condition. If we have any concerns about your fitness for work, your employment will be subject to satisfactory medical reports.
35. Do you have any reason to believe you may be infected with any communicable disease?
    
    *

    1. Yes
    2. No
36. If yes, please specify.
37. Do you have a current or recent medical condition or treatment which might affect your attendance or performance at work?*

    1. Yes
    2. No
38. If yes, please specify.
39. Has any illness or medical condition prevented you from attending work on your normal duties or activities for more than one week during the past year?*

    1. Yes
    2. No
40. If yes, please specify.
41. Do you have any physical or mental impairment which has a substantial and long-term effect on your ability to carry out day to day activities?
    
    *

    1. Yes
    2. No
42. If yes, please specify any special adjustments required in relation to work.
43. Do you smoke?*

    1. Yes
    2. No
44. How many units of alcohol do you drink per week? (one unit = 1 middy beer = 1 glass wine = 1 shot of spirits) *
45. Do you intend to work night duties on a regular basis?*

    1. Yes
    2. No
46. Imagine you have been on your feet all day. A client/patient you have been dealing with is rude and impatient, what do you do?*
47. What do you think is the most difficult part about nursing or caring for clients?*
48. Do you have a full current driver's licence?
    
    (If yes, please upload this to the attachments section - this is not mandatory)*

    1. Yes
    2. No
49. Do you have comprehensive car insurance?*

    1. Yes
    2. No
50. Do you declare that the information you have provided above is true and correct?*

    1. The information provided is true and correct.