You are applying for the position:

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Application Form (All fields are required)

1. Residency:
Are you currently legally entitled to work in NZ?

2. Residency:
Please indicate your current residency status

3. Current / Previous Employee:
Are you currently or have you previously been employed by Healthscope NZ Ltd or any of its subsidiary companies?

4. Current / Previous Employee:
If yes please detail where, what position and dates. If you answered no to question 1, simply write NA here.

5. Drivers Licence?:
Do you hold a current valid Drivers Licence?

6. Employment:
Would this position be your sole employment?

7. Availability:
How soon would you be available to commence employment?

8. Availability:
Are you able to work rostered shifts, weekends and/or additional hours if required?

9. Health:
Do you have any health related issues which may impact on your ability to perform the tasks of the position you are applying for?

10. Health:
Have you in the past or do you now suffer from conditions that might contribute to a gradual process injury (OOS)?

11. Health:
Are you allergic to or do you have any sensitivty to any substances or chemicals? If yes, please detail

12. Criminal Convictions:
Do you have any present criminal convictions, not including any concealed under the Clean Slate Act?

13. Criminal Convictions:
Are you awaiting the hearing of charges in a civil or criminal court of law?

14. Disciplinary Action :
Have you ever had professional disciplinary action initiated against you?

15. Preferred Area or Department to work in.:
Do you have a particular discipline you are interested in i.e. Micro, Biochem, Haematology, Immunology, Histology, Patient Services, Courier. Please provide a brief outline of the experience you have in your preferred area.

16. Qualification:
Are you a qualified Scientist or Technician and are you registered with NZ Medical Science Council? Provide a brief outline of your qualification if you have one.

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