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Vet Nurse Registration FormJulie South

VETERINARY NURSE REGISTRATION FORM

Step 1 of 4 - CONTACT INFO & QUALIFICATIONS

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  • if your preferred name is different to your first name
  • Will your address be a PO Box or physical street address?
  • This field is hidden when viewing the form
  • This field is hidden when viewing the form
  • This field is hidden when viewing the form
  • Please enter N/A if you don't hold a university qualification
  • Emergency Contact Person

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  • Work Experience - last 5 years

  • Practice NameTypeLocationTime employed
  • Practice NameTypeLocationTime employed
  • Practice NameTypeLocationTime employed
  • Practice NameTypeLocationTime employed
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  • PRACTICE PREFERENCE

  • please select as many places / cities / regions as you would like
  • please elaborate on any complex surgery information you'd like us to know about.
  • please elaborate on any special interests and/or specialties you'd like us to know about
  • please tell us about further post-grad studies you've undertaken here
  • Do you have special conditions regarding locum work it's important for us to know about?
  • Hourly RateDaily Rate 
  • Please list any clinics you've previously locumed at so we don't approach these clinics on your behalf.
  • Please use a new line for each clinic / job. If you've applied through Seek or Trade Me please list the job references (if possible).
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  • REFEREES

    Please be assured we will NOT contact any referees until you give us permission to do so.
  • NameContact Tel NoEmail AddressRelationship 
  • NameContact Tel NoEmail AddressRelationship 
  • NameContact Tel NoEmail AddressRelationship 
  • Accepted file types: pdf, docx, doc, Max. file size: 8 MB.
  • Accepted file types: png, jpg, jpeg, Max. file size: 5 MB.
  • I understand that VetStaff will treat this information in the strictest confidence.

    I further understand that providing this information in no way obligates me to accept any locum work VetStaff may offer me, nor does it guarantee that VetStaff will offer me locum assignments - if that is the work I am seeking.

    I confirm all the information I have provided herewith is true and accurate.

    In the event I have already applied for jobs and/or sent my CV to clinics I have listed these here.

    I confirm I am not withholding any information and have answered every question honestly and truthfully.
  • DD slash MM slash YYYY
  • This field is for validation purposes and should be left unchanged.
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