Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
This form is for internationally qualified nurses and midwives applying for By signing this form, you confirm that you have read the collection statement. AHPRA’s
general registration as an enrolled nurse, registered nurse or midwife in privacy policy explains how you may access and seek correction of your personal
Australia. Applicants are directed to the Nursing and Midwifery Board of information held by AHPRA and the Board, how to complain to AHPRA about a breach of
Australia’s (NMBA) website for the criteria to be satisfied for registration by an your privacy and how your complaint will be dealt with. This policy can be accessed at
www.ahpra.gov.au/privacy.
applicant from overseas www.nursingmidwiferyboard.gov.au/Registration-
and-Endorsement/International Symbols in this form
You must complete this application yourself. It may not be completed by Additional information
someone else on your behalf. Provides specific information about a question or section of the form.
It is important that you refer to the NMBA’s registration standards, codes and
guidelines before completing this application. These documents can be found Attention
at www.nursingmidwiferyboard.gov.au Highlights important information about the form.
If you are applying for registration following the successful completion Attach document(s) to this form
of an NMBA-approved bridging program you must use the form Processing cannot occur until all required documents are received.
AGBP-40, which can be found at www.nursingmidwiferyboard.gov.
au/Registration-and-Endorsement/Forms Signature required
Requests appropriate parties to sign the form where indicated.
If you have the legal authority to practice as a nurse or midwife in
New Zealand, you are subject to certain entitlements under the Mail document(s) directly to AHPRA
Trans-Tasman Mutual Recognition Act 1997 (Cth) and should apply Requires delivery of documents by an organisation or the applicant.
for registration using form ATMR-40, which can be found at
www.nursingmidwiferyboard.gov.au/Registration-and- Completing this form
Endorsement/Forms • Read and complete all questions.
This application will not be considered unless it is complete and • Ensure that all pages and required attachments are returned to AHPRA.
all supporting documentation has been provided. • Use a black or blue pen only.
Supporting documentation must be certified in accordance with the
• Print clearly in B L O C K L E T T E RS
Australian Health Practitioner Regulation Agency (AHPRA) guidelines.
For more information, see Certifying documents in the Information • Place X in all applicable boxes:
and definitions section of this form. • DO NOT send original documents unless specified.
The information items in this section of the application that are marked with an asterisk (*) will appear on the public register.
City/Suburb/Town of birth
After hours
7. Is the address of your YES Provide your Australian principal place of practice below
NO
principal place of practice
the same as your residential Site/Building and/or position/department (if applicable)
address?
Principal place of practice
for a registered health
practitioner is:
• the address at which you
predominantly practise the Address (e.g. 123 JAMES AVENUE; or UNIT 1A, 30 JAMES STREET)
profession, or
• your principal place of
residence, if you are not
practising the profession
or are not practising the
profession predominantly
at one address.
Principal place of practice City/Suburb/Town*
cannot be a PO Box.
The information items marked
with an asterisk (*) will appear State/Territory* (e.g. VIC, ACT) Postcode*
on the public register.
Address/PO Box (e.g. 123 JAMES AVENUE; or UNIT 1A, 30 JAMES STREET; or PO BOX 1234)
City/Suburb/Town
Country (if other than Australia)
You must provide evidence that satisfies the NMBA’s criteria for internationally qualified nurses and midwives. Information
about these criteria is found at www.nursingmidwiferyboard.gov.au/Registration-and-Endorsement/International
9. Have you recently completed YES NO
an NMBA-approved bridging
program and are applying for You are not eligible to use this application form. To apply for general registration as an
registration based on your internationally qualified nurse or midwife, please complete application form AGBP-40, available
successful completion at www.nursingmidwiferyboard.gov.au
of this course?
Country
You must attach a certified copy of all your academic qualifications and examinations/
assessments mentioned in this form. Following assessment of your application, you may be
requested to provide further information.
Country
You must attach a certified copy of all your academic qualifications and examinations/
assessments mentioned in this form. Following assessment of your application, you may be
requested to provide further information.
Attach a separate sheet if all your qualifications do not fit in the space provided.
Attach a separate sheet if all your registration history does not fit in the space provided.
14. Do you have any criminal It is important that you have a clear understanding of the definition of criminal history. For more information, see
history in Australia? Criminal history in the Information and definitions section of this form.
YES NO
You must attach a signed and dated written statement with details of your criminal history in
Australia and an explanation of the circumstances.
17. Which one of the English If a qualification that was relied on for registration is not an approved program of study, you must provide
language competency confirmation that the course was taught and assessed solely in English. A list of approved programs of study is
pathways do you meet? available at www.ahpra.gov.au/Education/Approved-Programs-of-Study
AHPRA may verify the Primary language pathway T his is a declaration that English is your primary language
information you provide below. Provide details of primary, secondary, vocational and/or tertiary
education in the table below, then go to question 21
For more information, see English
language skills in the Information Extended education pathway P
rovide details of secondary, vocational and/or tertiary education
and definitions section of this form. (registered nurse and/or midwife) (including two years in a pre-registration tertiary program) in the table
below, then go to question 21
Extended education pathway P
rovide details of secondary, vocational and/or tertiary education
(enrolled nurse) (including one year in a pre-registration vocational program) in the table
below, then go to question 21
English language test pathway Go to question 18
If you meet the English language test pathway, you do not need to complete the table below. Please proceed to question 18.
Complete the following table of education undertaken in chronological order (earliest to most recent):
Level of Program name Education institution Recognised country Study
Timeframe
education If applicable Specify name and address If applicable status
Study commenced: Primary Australia Canada Full time
MM Y Y Y Y Secondary New Zealand epublic of
R Part time
Ireland
Study completed: Vocational South Africa
United
MM Y Y Y Y Tertiary United States Kingdom
Study commenced: Primary Australia Canada Full time
MM Y Y Y Y Secondary New Zealand epublic of
R Part time
Ireland
Study completed: Vocational South Africa
United
MM Y Y Y Y Tertiary United States Kingdom
Study commenced: Primary Australia Canada Full time
MM Y Y Y Y Secondary New Zealand epublic of
R Part time
Ireland
Study completed: Vocational South Africa
United
MM Y Y Y Y Tertiary United States Kingdom
Please attach a separate sheet with any additional details that do not fit in the space provided above.
If a qualification specified above was relied on for registration and is not an approved program of study, you must provide a certified
copy of your academic transcript confirming that the course was taught and assessed solely in English.
If the transcript does not confirm that the course was taught and assessed solely in English, you must arrange for a letter in the required form
to be provided directly to AHPRA by the education provider confirming that the course was taught and assessed solely in English.
18. Were your results from In certain circumstances, you can use English language test results from a maximum of two test sittings in a six
the English language tests month period. For more information, refer to the NMBA’s English language skills registration standard.
obtained in one or two One sitting Provide date of test below, then go to the next question and complete details for one sitting
sittings? Two sittings Provide dates below, then go to the next question and complete details for both sittings
19. Which of these English language tests have you successfully completed?
Provide reference number(s) for the test(s) you are relying on and attach a copy of your test results.
The NMBA requires the PTE Academic with a minimum overall score of 65 and a minimum score of 65 in each of the four communicative skills (listening,
reading, writing and speaking).
Test of English as a Foreign Language internet-based test (TOEFL iBT)
Registration number – sitting one: Registration number – sitting two (if applicable):
The NMBA requires the TOEFL iBT with a minimum total score of 94 and the minimum scores of 24 for listening, 24 for reading, 27 for writing, and 23 for
speaking.
If your English language test(s) were completed within the past two years, you must provide a copy of your test results, including
the reference number(s), so that AHPRA can verify your results.
If your English language test(s) were not completed within the past two years, you must provide a certified copy of your results.
You must attach a certified copy of your English language test results, and:
• your CV and a letter from employer(s) or a professional referee in the required form
confirming continuous employment as a registered health practitioner in a recognised
country (if you are relying on continuous employment over two years in duration, only
two years is required), and/or
• an academic transcript evidencing that you were enrolled continuously in an NMBA-approved
program of study that commenced within 12 months of sitting the English language test, and
that you completed your study no longer than 12 months before lodging your application.
21. Do you commit to having F or more information, see Professional indemnity insurance in the Information and definitions section of this form.
appropriate professional
indemnity insurance (PII) YES NO Y ou must not practise the profession unless you are
arrangements in place for covered by appropriate PII arrangements in accordance
all practice undertaken during with the requirements of the NMBA.
the registration period?
24. Do you have an impairment more information, see Impairment in the Information and definitions section of this form.
For
that detrimentally affects, or is
likely to detrimentally affect, YES NO
your capacity to practise
nursing and/or midwifery?
You must attach to this application details of any impairments and how they are managed.
SIGN HERE
to professional services provided by health practitioners or the regulation of
health practitioners.
h) the practitioner’s registration under the law of another country that provides
for the registration of health practitioners is suspended or cancelled or made
Name of applicant subject to a condition or another restriction.
Change in principal place of practice, address or name
6. A registered health practitioner must, within 30 days of any of the following changes
Date happening, give the National Board that registered the practitioner written notice of
D D / MM / Y Y Y Y the change and any evidence providing proof of the change required by the Board—
a) a change in the practitioner’s principal place of practice;
b) a change in the address provided by the registered health practitioner as the
address the Board should use in corresponding with the practitioner;
Obligations of registered health practitioners c) a change in the practitioner’s name.
The National Law pt 7 div 11 sub-div 3 establishes the legislative obligations of Employer’s details
registered health practitioners. A contravention of these obligations, as detailed at points 7. A National Board may, at any time by written notice given to a health practitioner
1, 2, 4, 5, 6 or 8 below does not constitute an offence but may constitute behaviour for registered by the Board, ask the practitioner to give the Board the following
which health, conduct or performance action may be taken by the Board. Registered information—
health practitioners are also obligated to meet the requirements of their Board as a) information about whether the practitioner is employed by another entity;
established in registration standards, codes and guidelines. b) if the practitioner is employed by another entity—
Continuing professional development (i) the name of the practitioner’s employer; and
1. A registered health practitioner must undertake the continuing professional (ii) the address and other contact details of the practitioner’s employer.
development required by an approved registration standard for the health profession 8. The registered health practitioner must not, without reasonable excuse, fail to
in which the practitioner is registered. comply with the notice.
You are required to pay an application fee, an overseas assessment fee and a registration fee.
Registration period
The annual registration period for the nursing and midwifery professions is from 1 June to 31 May.
If your application is made between 1 April and 31 May this year, you will be registered until 31 May next year.
Refund rules
The application fee and overseas assessment fee are non-refundable. The registration fee will be refunded if the application
is not approved.
31. How are you paying your fees?
Mark one box below only
Payment by cheque, money
Visa or MasterCard Cash/EFTPOS
order or bank draft must be
Complete credit/debit card payment slip below (only available if paying in person)
in Australian currency, drawn
on an Australian bank. Cheque/Money order/Bank draft
A receipt will be provided.
You must attach cheque or money order payable to the Australian Health Practitioner
Regulation Agency.
On the back of the cheque, money order or bank draft, you must write:
• your full name
• your date of birth, and
• your AHPRA registration number (if you have one).
$
Cardholder’s signature
Visa or MasterCard number
Question 4 Certified copies of all documents that provide sufficient evidence of your identity
Question 10 Certified copies of all of your academic qualifications and examinations/assessments mentioned within this form
Question 12 Certificate of Registration Status or Certificate of Good Standing has been requested from relevant authority
Question 13 A Statement of Service from your employer(s) covering the past five years
Question 14 A signed and dated curriculum vitae that describes your full practice history and any training undertaken
Question 14 A signed and dated written statement with details of your criminal history in Australia and an explanation of the circumstances
Question 15 A separate sheet of additional overseas countries with criminal history and corresponding ICHC reference number
Question 15 A signed and dated written statement with details of your criminal history outside Australia and explanation of the circumstances
Questions
ICHC reference page provided by the approved vendor
15 & 16
Question 16 A separate sheet of additional overseas countries lived in and corresponding ICHC reference number
Question 26 A separate sheet with details of your conduct, performance or health proceedings in Australia or overseas
Question 29 A separate sheet with your previous cancellation, refusal or suspension details
Question 30 A separate sheet with your previous conditions, undertakings or limitation details
Payment
Application fee
Overseas assessment fee
Registration fee
If paying by cheque/money order/bank draft, your name, date of birth and registration number are written on the back
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