Application Checklist And Statement Of Employment Page 3
Download a blank fillable Application Checklist And Statement Of Employment in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Application Checklist And Statement Of Employment with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1
2
3Application Guidelines – B-NURS Bachelor of Science (Nursing)
STRU-AREGN Registered Nurse Conversion Australian Registration Nurse Stream
STRU-CNVRN Registered Nurse Conversion Non-Registration Nurse Stream
Statement of Employment Template
(To be completed by current and/ or previous employer)
*Please ensure that boxes are filled in completely*
Details of Person completing this form
Name:
Position:
Organisation:
Relationship to Applicant:
Details of Applicant
Name of Applicant:
Names of organization where
clinical experience was
obtained (Title/ Position of
Clinical Role):
Contract Start Date:
Contract Status/ End Date:
Description of the Type of Clinical Experience Obtained
Description of Clinical Setting
No. of hours worked
No. of beds/patients
Medical
Surgical
Paediatrics / Maternal & Child Health
Mental Health
Critical Care & Emergency
Community & Primary Health Care
Total Number of Clinical Experience Hours
Additional Comments regarding employment status (if applicable):
Attached is an official letter confirming employment from my employer
Attached is a Job Description Form (JDF) from my employer
Declaration by Clinical Work Experience Employer
I acknowledge that the clinical hours and roles described within this statement of employment are true and correct and,
have been undertaken by
(Name) _______________________________ within _______________________________ (Name of Organisation)
Signed: ________________________________ Date: ________/ ________/ _________ (DD/MM/YYY)
Print Name of Signatory: _______________________ and Job Title:_______________________________________
Contact Details
* Please note that your contact details are required for verification. Please ensure that you provide current contact details
Phone:
Address:
Email:
3
ADVERTISEMENT
0 votes
Related Articles
Related forms
Application For Authenticated Statement Of No Marriage In Michigan - Michigan Department Of Health
Legal
Medicare Secondary Payer Statement Of Employer In Support Of Application For Small Employer Exception
Medical
Form Tc244 - Attachment To Application - Agent's Statement Of Authority And Knowledge - Nyc Tax Commission - 2004
Financial
Form 14204 - Tax Counseling For The Elderly (tce) Program Application Checklist And Transmittal - 2011
Financial
Form 14204 - Tax Counseling For The Elderly (tce) Program Application Checklist And Contact Sheet
Financial
Form 14204 - Tax Counseling For The Elderly (tce) Program Application Checklist And Contact Sheet
Financial
Related Categories
Parent category: Legal