Name *

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Date of birth

MM

DD

YYYY

Person to contact in case of an emergency

First Name

Last Name

Emergency contact phone number

(###)

###

####

Are you an Australian or NZ citizen? *

Yes

No

If no, do you have an Australian working visa? *

Yes

No

Which dialysis machines can you operate? *

Fresenius 4000 series

Fresenius 5000 series

Gambro AK series

Gambro Artis

Require refresher training

NA

Where would you like to work?

Metropolitan Sydney

Regional NSW

QLD

SA

WA

NT

ACT

VIC

Tas

Private patient/home dialysis

Essential criteria is required for an interview if you can please tick forms you can present at your interview:

National Criminal Record Check

NSW Working with Children Check (if applicable to you)

AHPRA certificate

Record of service (from current/previous employer) stat dec signed by JP

Overseas applicant visa (if required)

100pt ID (passport, driver's licence, bank card or utilities bill)

Vaccination record card and serology reports (MMR, HepB, Varicella, TB, DTPA)

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