1. Please indicate the level of employment you are seeking (please note, for positions at Grade 7 / NO4 level and above, see advertised vacancies available from www.health.qld.gov.au/jobs

2. What is your primary specialty?

Aged Care Aged Care - Continence Aged Care - Gerontology Aged Care - Rehabilitation Community & Child Health Community & Child Health - Asthma Community & Child Health - Child Health Community & Child Health - Community Health Community & Child Health - Diabetes Community & Child Health - School Based Youth Health Nurse Community & Child Health - School Health Critical Care / Emergency Critical Care / Emergency - Cardiothoracic Intensive Care Critical Care / Emergency - Coronary Care Critical Care / Emergency - Emergency / Trauma Critical Care / Emergency - High Dependency Critical Care / Emergency - Intensive Care Medical Medical - Cardiology Medical - Endocrinology Medical - Gastroenterology Medical - General Medical Medical - Neurology Medical - Oncology / Haematology Medical - Palliative Care Medical - Renal / Nephrology Mental Health Mental Health - Adult Mental Health Mental Health - Child & Adolescent Mental Health Mental Health - Forensic Mental Health - General Mental Health Mental Health - Psychogeriatric Midwifery Midwifery - Antenatal Midwifery - Birth Suites / Labour Midwifery - General Midwifery Midwifery - Lactation Midwifery - Neonatal Intensive Care Midwifery - Postnatal Other - Infection Control Other - Management Other - Nursing Education Other - Nursing Research Other - Quality Improvement Paediatrics Paediatrics - General Paediatrics Paediatrics - Paediatric Intensive Care Paediatrics - Paediatric Medicine Paediatrics - Paediatric Oncology Paediatrics - Paediatric Surgery Perioperative Perioperative - Anaesthetic Perioperative - Other Perioperative - Perioperative / Theatre Perioperative - Recovery / Post Anaesthetic Care Public Health Public Health - Alcohol, Tobacco & Other Drugs (ATODS) Public Health - Health Promotion Public Health - Sexual Health Public Health - Women's Health Rehabilitation Rehabilitation - Acute Adult Rehabilitation Rehabilitation - Community Based Rehabilitation Rehabilitation - Paediatric Rehabilitation Rural / Remote Rural / Remote - Remote Area Nurse Rural / Remote - Rural Generalist Surgical Surgical - Burns & Plastics Surgical - Cardiothoracic Surgical - ENT Surgical - General Surgical Surgical - Gynaecology Surgical - Neurosurgical Surgical - Ophthalmology Surgical - Orthopaedic Surgical - Urology Surgical - Vascular
(Ctrl key & mouse button to select more than one)

2(a). Do you have a sub-specialty or area of interest?

3. Do you seek permanent or temporary employment opportunities?

3(a). If Temporary:

3(b). If Permanent:

4. What is your preferred location of employment in Queensland?

4(a). In some cases there may not be suitable opportunities available within your preferred location. This may particularly be the case within the south-east corner of Queensland, as positions within these metropolitan areas are often highly sought after.

If there are no suitable vacancies within your preferred location, please indicate whether you would consider other locations and where?

4(b). Would you like to work in one location, or would you like opportunities to move around?

PERSONAL DETAILS: *

5. Family name:

6. Given names:

Title:

(eg. Dr/Prof/Mr/Mrs/Ms)

7. Date of birth: (dd/mm/yyyy)

(used to eliminate duplicates, to confirm Visa entitlements and for validation purposes only)

8. Contact telephone numbers: (please include international code and area code)

9. Email: (please note email is our primary method of contacting you) *

10. Postal Address:

ENGLISH LANGUAGE PROFICIENCY

A high level of English Language proficiency is essential to enable practitioners to communicate with patients and health professionals and for maintenance of professional standards. Individuals must submit evidence of competency in speaking and communication in English, to an acceptable standard, in order to obtain registration with the Queensland Nursing Council (QNC). In some cases, the QNC may provide exemptions to English Language Proficiency requirements.  For further information please refer to www.qnc.qld.gov.au.

The English Language Proficiency Tests that QNC accept are: International English Language Testing System (IELTS), Occupational English Test (OET) or International Second Language Proficiency Ratings.

LANGUAGE SKILLS:

11. Please indicate the language competency test that you have completed: *

11(b). If you have completed the IELTS or OET examinations, please indicate scores in all four components:

RESIDENCY STATUS

12. What is your residency / visa status?

13. What is the name of your visa class and sub-class, plus expiry date as shown on your passport (if applicable)?

NURSING QUALIFICATIONS

14. Please provide details of your primary nursing qualifications: *

15. Please provide details of any post-graduate nursing qualifications:

16. Have you commenced registration processes with the Queensland Nursing Council?

NURSING REGISTRATION STATUS

17. Please indicate your registration status: *

CURRENT AND PREVIOUS POSITIONS (important details only):

18. Please list details of your current and your most recent positions: *

VERIFICATION OF QUALIFICATIONS AND WORK EXPERIENCE: *

I verify that the information contained within this Expression of Interest form and attached Curriculum Vitae is true and correct at the date of submission.  I acknowledge that should I be invited for an interview with a Health Service District (and appointed, if successful) that I will be required to provide an original Curriculum Vitae that is signed and includes the following statement on the first page "This Curriculum Vitae is true and correct as at <insert date>"

CONSENT:

“I agree that Queensland Health may, for the purposes of verifying my qualifications, use and disclose my personal details contained in this form, including disclosure to professional and regulatory bodies.”

DISCLOSURE

21. Have you been subject to disciplinary action by a Nursing Registration Board at any time? *

TERMS AND CONDITIONS FOR SUBMITTING AN EXPRESSION OF INTEREST

These terms and conditions govern your submission of the Expression of Interest Form (the “Form”) and your access to and use of the Form and related web pages. By using or submitting this form you agree to be bound by these terms and conditions.

• You must complete all sections of the Form. If you do not complete the Form we will be unable to assess your suitability for a position with Queensland Health and will be unable to notify you of any vacancies. The information provided by you will be valid for a period of up to 12 months and will only be retained by Queensland Health for a period of up to 12 months. After this period has expired we will dispose of the information and you will need to submit a new Form. If you wish to update any information you have submitted in the Form you will also need to submit a new Form.
• Personal information you provide in this form will be used by Queensland Health for employment related purposes and / or to determine your suitability for employment within the public health system in Queensland. In addition, we may use your information for statistical purposes; however any information will be de-identified for this purpose. Queensland Health reserves the right to use and disclose the information provided by you in the Form to verify your qualifications and / or standing, including disclosing your information to professional and / or regulatory bodies. We will not disclose your information for any other purpose unless we obtain your consent, or we are required or permitted to do so by law or in accordance with the requirements of Information Standard 42A – Information Privacy for the Queensland Department of Health (“IS42A”). Your information, contained in this Form, will be potentially open for release under the Freedom of Information Act 1992, Queensland. You can access this legislation through the following link: http://www.legislation.qld.gov.au/LEGISLTN/CURRENT/F/FreedomInfoA92.pdf
• While Queensland Health endeavours to ensure that the online transmission of the Form, containing your information, over the internet is secure, the inherent nature of the internet means that there is a potential risk that your information may be viewed or intercepted by third parties. Accordingly, submission through the online Form shall be at your own risk and Queensland Health accepts no responsibility or liability for any unauthorised access to your information contained in the Form when it is submitted online over the internet. Individuals who submit the Form online should receive an acknowledgement from Queensland Health that the Form has been sent, on the screen, following submission. Queensland Health accepts no responsibility or liability if this acknowledgement does not appear or we do not receive your online submission.
• Queensland Health makes no representation at the time the Form is submitted or any time in the future, that there is a suitable position or any position, available to you, or that you will be considered for a position that becomes available in Queensland Health. In addition, Queensland Health makes no representation that by submitting your Form you will be notified of any or all appropriate vacancies; offered an interview in relation to a vacant position; or be offered a position with Queensland Health.
• You warrant that the information you submit on this Form is accurate and complete at the time of submission. You also warrant that you have not submitted the Form on behalf of any other person.

I hereby accept and agree to abide by, the above terms and conditions for submitting this Form. *

DECLARATION:

I declare the information on this form to be correct at the time of submission. *

FEEDBACK:

22. How did you become aware of career opportunities with Queensland Health: *(Min 1 - Max 3)

23. Any other comments relevant to your Expression of Interest?

Work for Us contact details:

Ph: 1800 000 093 (within Australia only) or +61 7 3636 9908
Email: workforus@health.qld.gov.au

* = Required fields