Alpha Nursing Online Application

How to fill out the application form

Please make sure you fill in all the red boxes before submitting your application.
Red boxes are mandatory fields look like this:  

In the date field, please type in date in this format 18/03/2008 or click the calendar button to pick a date.
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Upon successful submission , you will get an application Id as an acknowledgement, otherwise please scroll up and click on all boxes one by one and look for any error message like this:



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Personal Details
Title
First Name
Last Name
Middle Name
Preferred Name
Date of Birth
Gender
Street Nos
Street
Suburb
State
Post Code
Driver's License
Language(s) spoken
other than English
Mailing Address (If different from residental address)
Street Nos
Street
Suburb
State
Post Code
If you are not an Australia citizen or permanent resident, please enter your working visa details here and call 9365 1755 to discuss your application
Working Visa Number  
Work Right Code  Expiry Date  
Work Hour Limit
Contact Details
Phone
Mobile
Email
Emergency Contact
Contact Name
Relationship
Emergency Phone
Emergency Mobile
Legal Issues
Police Check Nos:
Issue date
In accordance with the Working with Children Act 2005, all agency staff nursing and non nursing working at the Royal Children's Hospital, Royal Women's Hospital and many other facilities must have a satisfactory Working with Children Check (WWCC). This requirement is effective from 1st July 2009.
Working with Children Check
WWCC Number
Issue date
Are there any court proceedings and or convictions against you that may hinder you from working in the Health/Aged Care sector?

Select Yes or No   

Please note that if you do not have a current Police check (within the last 12 Months) you will need to authorise us to arrange one on your behalf. You can download, complete and bring the application with you to our interview. Click Here to download Police Check Form
Professional Update
Training
Training School
Completion date
Qualifications
University/Training School
Completion date
Registration Nos
Classification




















Post basic qualification






















Other Qualifications
Health Status
Do you have an acute medical condition?
Do you have any existing Injuries?
Are you currently on any medications?
Any allergies/adverse drug reactions?
Have you had any work cover claim within the last two years?
Immunisation
MMR required for DOB post 1966





Other
Employment History 1
Facility Name
From
To
Position Held
Reason for leaving
Employment History 2
Facility Name
From
To
Position Held
Reason for leaving
Please provide at least two professional references
Professional Referee 1
Referee Name
Position and Facility
Contact Details
Your position held
Professional Referee 2
Referee Name
Position and Facility
Contact Details
Your position held
Professional Referee 3
Referee Name
Position and Facility
Contact Details
Your position held
Work Details *** optional ***
Name of previous agency (if any)
Name of current employer (if any)
I would travel up to (enter KMs)  (enter 3 numbers only)
Do not call in early morning (from 5:30 AM)
Do not call unless I put in availability
I prefer to work at:
(do not select them all)
Leave it blank if you have no perference

Name of facilities I prefer to work at
Name of facilities I'd rather not work at
How did you hear about us? (Please fill in)
Name of Newspaper
Area (Local paper)
Expo (where)
Word of mouth (Who)
Other (Please specify)
Preferred Interview Venue

Declaration and Signature

I, the undersigned, advise that the above information, that I have supplied, is true and correct. I further understand that if I have deliberately supplied false or misleading/misrepresented information Alpha Nursing (Alpha) will not provide me with available shifts. As such, I authorise Alpha and any of its officers to conduct any enquiry regarding my qualifications, employment history and work patterns, based upon the information that I have supplied.

It should be further noted that any information supplied by you can be used to obtain work on your behalf or given to a statutory and or government department when lawfully requested.

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Please type your name here:   

Nothing happens after clicking the submit button???

Please scroll all the way back up, click on all the boxes one by one and pay attention to the yellow error box, rectify error as you go. Make sure you enter date like this "01/19/2009", use only charactor, space and number in other boxes. Submission will also fail if you have not filled in all the red boxes, browser security set too high, cookie disabled or there is page error (shown on status bar at left bottom corner).