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Austra Health Online Registration Form

To complete this form you will need to have access to the following information:

  • Your Australian Work Visa number if applicable
  • Your resume in digital format to upload (PDF, DOC, DOCX, RTF, TXT format acceptable)
  • Name and contact details for at least two professional referees
  • Your Working With Children Check (WWCC) number and issue date (if you have one)

Note: Asterix (*) indicates a mandatory field. Phone numbers should be numbers only (no spaces)

Personal Details
First Name*:
Middle Name:
Surname*:
Preferred Name:
Date of Birth (Optional - for superannuation purposes only):
Gender:
Email Address*:
Home Phone:
Mobile Phone*:
Do you have your own transport?
Languages spoken other than English:
Are you an Australian Citizen / Resident?*
If no, do you give permission for Austra Health to contact the Department of Immigration to check your work right status?*
Visa Number*:
Are you currently on any other Hospital Nurse Banks?*
If yes which ones?
Are you happy to recieve early AM calls?
How did you hear about us?

Residential Address

  
Address Line 1*:
Address Line 2:
Suburb*:
Postcode*:
State*:

Mailing Address Same as Above

 
Addresss Line 1:
Addresss Line 2:
Suburb:
Postcode:
State:

Emergency Contact

  
Contact Name*:
Relationship*:
Phone:
Mobile*:

Working With Children Check
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, Western Health and many other facilities must have a satisfactory Working with Children Check (WWCC). This requirement is effective from 1st July 2009.
Do you have a current WWCC in Victoria?*
(if no, this may restrict the hospitals or positions you may be able to work at)
WWCC Number:
Issue Date:
Are there any previous or pending court proceedings and or convictions against you that may hinder you from working in the Health/Aged Care sector?*
Note: If any of the above changes whilst employed by Austra Health, it is in your duty to notify Austra Health immediately.
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