1.Personal Details - (Please Complete All Details Electronically)

APPLICATION FORM GRADUATE ENROLLED NURSE

August2016 ACT Health Transition to Practice Program

1.Personal Details - (Please complete all details electronically)

Surname:
First Name:
Residential Address:
State/Territory:
Email address:
Telephone: (Home) (Mobile)

Eligibility – (Please complete all details electronically)

I have completed/will complete my Diploma in Nursing in 2015/2016 Yes  No 
Are you currently registered: Yes  No 
If no when will you be eligible to register with the Australian Health Practitioner Regulation Agency (AHPRA)?Please note this must occur prior to program commencement.
Are you an Australian Citizen / Permanent Resident? Yes  No 
If no, do you hold a current valid visa that allows you to work in Yes  No 
Australia (this includes New Zealand citizens): Details: ......

Commencement Date

 August 2016
4. Referee Details – (Please attach two professional written referee reports)
Name of referee 1: / Name of referee 2:
Organisation: / Organisation:
Position Held: / Position Held:
Email: / Email:
Telephone: (Business Hours) / Telephone: (Business Hours)

5. Duty Statement – Enrolled Nurse

1. Provides competent and safe patient care within an ethical, professional and quality framework and practices in accordance with the relevant legislation. Integrates; organisational policy and guidelines with professional standards.
2. Adheres to the scope of practice of a graduate enrolled nurse. Aware of differences in accountability and responsibility between EN and RN and undertakes role according to the appropriate standard.
3. Considers and advocates for individuals and/or groups and their rights for nursing care within the organisational and management structure.
4. Be responsible for completing all professional development requirements and demonstrating competency as a beginning enrolled nurse within the graduate nurse program in the required timeframes.
5. Practices in a way that acknowledges the dignity, culture, values, beliefs and rights of individuals and/or groups. Adhere to safe practice and relevant legislation,

6. Selection Criteria(please complete electronically)

Please read the selection criteria carefully and type your response on page 3 and 4

In no more than 2 pages(half a page per question)answer each selection criterion.
Include an example of how you have demonstratedeach criterionin your professional nursing practice to deliver quality patient care.

Outline your professional responsibilities as an EN in the clinical environment.

Describe how you will implement the four ACT Health Core Values into your clinical practice?

How do you ensure that you are an effective member of the healthcare team?

Explain why the Nursing Process is essential in your patient care?

Please complete this electronically as part of the Application Form usingArial 11 font, single spacing and standard margins.

Note: Please keep statement within the recommended two page limit

Selection Criteria .1.

Selection Criteria .2.

Selection Criteria .3.

Selection Criteria .4.

7. Selection Process

Employment decisions will be based on:

Completed application form inclusive of the two page selection criteria(4 questions)
Referee reports (Professional) x 2 – Required: 1 x clinical and 1 x paid employment or 2 x clinical
Satisfactory CIT / TAFE - Academic history to date
Short listing will take place from the above submitted documentation. Short listed applicants will be invited to attend an Interview and Assessment Centre on either the 6th & 7th June 2016. At this time all elements of the application process will be considered including performance at Interview and assessment at the Assessment Centre.

8. Final checklist – (Please ensure you have attached all documents)

Curriculum Vitae attached

CIT / TAFEunofficial or official transcript attached

Read and Acknowledged Duty Statement of a Enrolled Nurse

Selection Criteria– 4 criterion (no more than 2 pages, Arial 11 font, single spacing) attached

I am an AustralianCitizen or Permanent Resident

I hold a current VISA (such as 485) that allows me to work in Australia

Two written professional referee reports using the ACT Health referee template attached

I have completed all sections of the application form and acknowledge the information provided is true and correct

eSignature of applicant: ______Date: ______

Closing date for applications is 22nd May

Please note that incomplete or late applications will not be considered.

If you have any questions please contact:

Enrolled Nurse Transition to Practice Program Coordinator:
or phone (02) 6244 3382; OR
Enrolled Nurse Clinical Development Nurses:
or phone (02) 62443360

9. Referee Reports – Template Attached(Please ensure you complete all documents)

/ REFEREE REPORT
EN Transition to Practice Program 2016
Applicant:
Referee name/title /work location: / Phone
Fax
Relationship to Applicant: / Period of working relationship:

Suitability against the selection criteria (Make either comments or a Rating, or both)

Criterion / Please make commentabout the applicant in relation to each criteria below using the rating scale (this criteria is generic to both clinical or non clinical, paid employment) / Rating as per attached scale
SC1 / Well developed communication and interpersonal skills / ( )1211109876543210
SC2 / Responsible, reliable and adheres to policy and regulations / ( )1211109876543210
SC3 / Commitment to customer service, equity and diversity / ( )1211109876543210
SC4 / Commitment to learning and strives for best practice / ( )1211109876543210

General Comments (eg, Attendance, general behaviour and attitude to work, quality of work and work skills, strengths, weaknesses, and areas for development.)

Is there anything else we need to know about the candidate which is relevant to our selection processes?

Have you provided a copy of this reference to the applicant?Yes No

Signature
Name of referee
Date:
/ REFEREE REPORT
EN Transition to Practice Program 2016
Applicant:
Referee name/title /work location: / Phone
Fax
Relationship to Applicant: / Period of working relationship:

Suitability against the selection criteria (Make either comments or a Rating, or both)

Criterion / Please make comment about the applicant in relation to each criteria below using the rating scale (this criteria is generic to both clinical or non clinical, paid employment) / Rating as per attached scale
SC1 / Well developed communication and interpersonal skills / ( )1211109876543210
SC2 / Responsible, reliable and adheres to policy and regulations / ( )1211109876543210
SC3 / Commitment to customer service, equity and diversity / ( )1211109876543210
SC4 / Commitment to learning and strives for best practice / ( )1211109876543210

General Comments (eg, Attendance, general behaviour and attitude to work, quality of work and work skills, strengths, weaknesses, and areas for development.)

Is there anything else we need to know about the candidate which is relevant to our selection processes?

Have you provided a copy of this reference to the applicant?Yes No

Signature
Signature of referee
Date:

10. Referee Report – Rating Scale

The assessment ratings as detailed below should be used by the Selection Advisory Committee to measure the performance of the applicant’s skills and abilities in respect of each of the selection criterion, as demonstrated in the job application, interview and Referee reports.

The alphabetical ratings may be adjusted (i.e. C-FC) in cases where the given rating does not best describe the assessment, and/or to assist in differentiating the performance of two or more applicants. (Assessments are to be recorded on the Selection Report Form)

This assessment rating scale is to be used for the entire process including short-listing, any assessment method including interviews, individuals and comparative assessments of applicants, and Referee reports.

ASSESSMENT AGAINST THE SELECTION CRITERIA

Scale / Description / Indicators of Performance
E / Excellent
On evidence available, the applicant has exceptionally well-developed and relevant skills and abilities, and the appropriate personal qualities in relation to this criterion, and his/her performance is outstanding i.e. above what would normally be expected of staff at this level. (To be used only in cases where exceptional skills have been demonstrated against this criterion.) / Is able to perform above expectations for any of the following reasons

excellent job knowledge
exceptionally reliable
considerable demonstrated ability in problem solving and the application of change
appears to instinctively and effectively deal with all matters relating to their current position

FC / Fully Competent
On evidence available, the applicant has highly developed and relevant skills and abilities, and would perform consistently again this criterion. / Would require little supervision to achieve good results, for any of the following reasons;

is reliable and responsible
has well developed (sound) job knowledge
is able to suggest and initiate improvement
is well able to deal with all of the routine and most of the complex matters relating to their current position

C / Competent
On evidence available, the applicant has relevant skills, abilities and personal qualities and would be generally effective against this criterion. / Would require routine supervision to perform at an acceptable level for any of the following reasons;

has reasonable/good job knowledge
makes few errors
is generally reliable
required guidance for more complex situations
can carry responsibility
can deal with all routine matters relating to their current position

RD / Requires Development
On the evidence available, the applicant has some skills, abilities and personal qualities relevant to the criteria, but is limited on others.
S/he would be able to temporarily perform the duties of the position with close supervision, but would require further training and development to meet the standard required against this criterion. / Would require close supervision to perform at an acceptable level for any of the following reasons

has only basic/general job knowledge
can follow directions but requires frequent checking etc
deals with some routine matters relating to their current position
inconsistent work performance

U / Unsuitable
On the evidence available, the applicant is unable to demonstrate that s/he has adequate skills, abilities and personal qualities in relation to the criteria. S/he does not meet the requirements of the criteria.
OR
Does not meet the criteria. / Would be unable to perform the duties and would require constant supervision for any of the following reasons;

has limited job knowledge
makes frequent errors
poor work output
has difficulty carrying responsibility or solving problems
has difficulty dealing with routine matters relating to their current position

ACT Health - Enrolled Nurse Transition to Practice Program Application Form 20161/11