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ASGR-40

*ASGR-40*

13. What are the details of your qualifications and examinations/assessments?

As a student completing studies at an Australian academic institution you may not yet have your qualification conferred, and are therefore unable and not required to provide a copy of your qualification with your application. Your application will be processed when the Board receives advice direct from the relevant education provider that you have met the requirements of the course and are entitled to the qualification.

For more information see Certifying documents in the Information and definitions section of this form.

Primary qualification and examinations/assessments Title of qualification

Name of institution (University/TAFE/RTO/College/Examining body)

Campus (name of campus/location of campus)

Country

Start date

Completion date

MM / Y Y Y Y

MM / Y Y Y Y

Profession applicable to Nursing

Midwifery

Length of program

If you have received your academic qualification you must attach a certified copy.

SECTION F: Suitability statements

Information required by the Board to assess your suitability for registration is detailed in the following questions. It is recommended that you provide as much information as possible to enable the Board to reach a timely and informed decision.

Please note that registration is dependent on suitability as defined in the National Law, and the requirements set out in the Board’s registration standards. Refer to www.nursingmidwiferyboard.gov.au/Registration-Standards for further information.

14. Do you have any criminal history in Australia?

It is important that you have a clear understanding of the definition of criminal history. For more information, see Criminal history in the Information and definitions section of this form.

YES

NO

Provide a separate sheet with details of your criminal history in Australia and explanation of circumstances.

15. Do you have any criminal history in another country?

YES

NO

For more information, see Criminal history in the Information and definitions section of this form.

Provide a separate sheet with details of your criminal history in another country and explanation of circumstances.

16. Do you commit to have appropriate professional indemnity insurance arrangements in place for all practice undertaken during the registration period?

YES

For more information, see Professional indemnity insurance in the Information and definitions section of this form.

NO

You must not practise the profession unless you are covered by appropriate PII arrangements in accordance with the requirements of the Board.

17. Do you have an impairment that detrimentally affects, or is likely to detrimentally affect, your capacity to practise nursing/midwifery?

YES

For more information, see Impairment in the Information and definitions section of this form.

NO

You must attach to this application details of any impairment and how it is managed.

Effective from: 9 September 2014

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