Graduate Psychiatric Nurse Program

2012

APPLICATIDN KIT 2012
NorthWestern hentaI HeaIth - Craduate PSYCHIATPIC Nurse Program
INSTPUCTIDNS:
F YDU AFE PAFTCPATNC N THE NUFSE CD|PUTEF |ATCH, YDU NEE0 TD LST NDFTHWESTEFN |ENTAL HEALTH AS DNE DF YDUF
PFEFEFENCES.
0D NDT USE THS FDF| to apply for the |elbourne Health CD|PFEHENS7E (Ceneral/|ental Health) CFA0UATE PFDCFA|.
A dIfferent form Is requIred.
1. Plecse wrte n 8lcck or 8lue pen usny 8LDCK LETTERS.
2. You must nclude wth ths ]orm:
Letter oj alcaton
Resum.
Certjed coy* oj academc transcrt - most recent (gradIng system codes provIded)
Certjed coy* Year 2 8 3 Clncal evaluatons (med/sury 8mental health)

J. lnclude cll supportny documents requested wth ths cpplccton .e. trcnscrpts o] results cnd
clnccl evclucton ]orms ]rom Yecr 2 8 J o] your deyree
4. Complete the cttcched clnccl rotcton pre]erence ]orm
5. All documents must be cert]ed cs true copes o] the oryncl documents.
6. The closny date jor alcatons s Thursday July 28
th
July 2011
1. TYPE DF APPLICATIDN: (PLEASE TlCK) CD|PUTEF |ATCH 0FECT
2. PEPSDNAL 0ETAILS
Surname: Computer |atch No:
CIven Names:
0ate of 8Irth: 7alId 0rIver's LIcence: YES ND
Address for correspondence:
Suburb/ Town: Postcode:
Telephone: Home: Work: |obIle:
EmaIl Address:
Are you currently regIstered as a 0IvIsIon 2 Nurse: YES: N87 0# ND
Are you an AustralIan CItIzen / Permanent FesIdent: YES ND
f ND, what Is your 7Isa status: Country of DrIgIn: Passport No:
7Isa Type: 7Isa ExpIry date:
3. ACA0EhIC UALIFICATIDNS:
A certIfIed* copy of your academIc transcrIpt(s) must be attached. Codes for gradIng must be IncIuded.
3.1 Undergraduate Program:
nstItutIon: Student 0:
Attended: From To
QualIfIcatIon: |ental Health |ajor: YES ND
3.2 Craduate Year ProgramlFIrst Year Post PegIstratIon ExperIence: (If any prIor graduate program or experIence)
EmployIng HospItal / Health ServIce:
Types of ClInIcal ExperIence:
0ate Completed:
Office Use Only:

Ref:
CM:
Interview:
NBV Reg:
PR:
WWC:
Graduate Psychiatric Nurse Program
2012


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4. PDLICE CHECK
ApplIcants wIll be requIred to undergo a natIonal PolIce Fecords Check (PFC) and In some cases a WorkIng wIth ChIldren
Check (WWCC) for preemployment screenIng purposes.
Have you been found guIIty of an offence (other than traffIc InfrIngement) of any nature In AustraIIa or overseas!
YES ND
f YES please attach provIde further InformatIon / documentatIon.
5. E0UCATIDN AN0 EhPLDYhENT HISTDPY
Enclose a Fesum (not bound) and Include:
all tertIary and/or nursIng qualIfIcatIons
employment hIstory (Include any prIor employment)
all nursIng experIence detaIlIng the length and type of experIence (Include dates)
any relevant nursIng short courses/semInars attended
6. PEFEPEES
Please provIde the contact detaIls of three referees. The ClInIcal referee should, where possIble, be able to comment on
your recent clInIcal performance relevant to mentaI heaIth l psychIatrIc nursIng. The Employer referee may be any
employer who can comment on your general work performance.
6.1 AcademIc Peferee:
Name:
DrganIsatIon:
PosItIon held:
Address:
EmaIl:
Tel: (busIness hours) |ob:
6.2 CIInIcaI Peferee:
Name:
DrganIsatIon:
PosItIon held:
Address:
EmaIl:
Tel: (busIness hours) |ob:
6.3 EmpIoyer Peferee:
Name:
DrganIsatIon:
PosItIon held:
Address:
EmaIl:
Tel: (busIness hours) |ob:
Graduate Psychiatric Nurse Program
2012


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7. 0escrIbe In your own words what you consIder to be the "Essence oj Psychatrc / Mental Health Nursny"
(Please complete thIs sectIon In handwrItIng. 0o not exceed space provIded)






























Graduate Psychiatric Nurse Program
2012


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NorthWestern |ental Health Is a multIsIte program. n order to provIde the hIghest qualIty Craduate Nurse Program, we
utIlIse the full range of servIces from wIthIn NW|H. These servIces are located In Area |ental Health ServIces across a
large portIon of |elbourne's western and northern localItIes, and are attached to the major hospItal for those areas.
Craduates may rotate from one Area |ental Health ServIce to another wIthIn the course of the Craduate PsychIatrIc Nurse
Program.
To assIst wIth your clInIcal placements please prInt your name, and number the boxes to IdentIfy your preferred
placements. You must seIect preferences In aII THPEE IIsts. AvaIlabIlIty of clInIcal rotatIons Is subject to many varIables
and as such your allocated rotatIon may vary from the selectIons you make. NW|H wIll make every effort to accommodate
your hIgher preferences, but cannot guarantee your preference.


NAhE:

CIInIcaI Venues LIst Dne (Acute)
lndcate your rejerences by numberny the boxes jrom 1 throuyh 5
1 beny your M0ST rejerred and 5 beny your LEAST rejerred

IndIcate
Preference
Number
1. Foyal |elbourne HospItal Acute Adult npatIent UnIt (John Cade 1)
2. SunshIne HospItal Acute Adult npatIent UnIt (SAAPU)
J. 8roadmeadows Health ServIce Acute Adult npatIent UnIt (8PU)
4. Northern HospItal Acute Adult npatIent UnIt (NPU)
5. Drygen Youth Program
Young Persons' Acute npatIent UnIt (Western HospItal
Footscray Campus)

CIInIcaI Venues LIst Two (Sub Acute)
lndcate your rejerences by numberny the boxes jrom 1 throuyh 6
1 beny your M0ST rejerred and 6 beny your LEAST rejerred

IndIcate
Preference
Number
1. Northern Area |ental Health ServIce Northern CommunIty Care UnIt (Preston)
2. |IdWest Area |ental Health ServIce St Albans CommunIty Care UnIt
J. North West Area |ental Health ServIce 8roadmeadows CommunIty Care UnIt
4. nner West Area |ental Health ServIce Norfolk Terrace CommunIty Care UnIt (FlemIngton)
5. Foyal |elbourne HospItal NeuropsychIatry/EatIng 0Isorders
6. SunshIne HospItal Adult |ental Health FehabIlItatIon UnIt
CIInIcaI Venues LIst Three (Aged)
lndcate your rejerences by numberny the boxes jrom 1 throuyh 3
1 beny your M0ST rejerred and 3 beny your LEAST rejerred

IndIcate
Preference
Number
1. SunshIne HospItal Aged Persons' Acute npatIent UnIt
2. 8roadmeadows Health ServIce Aged Persons' Acute npatIent UnIt

NorthWestern |ental Health collaborates wIth PoyaI ChIIdren's HospItaI - ntegrated |ental Health Program. A lImIted
number of placements Is avaIlable at 8anksIa UnIt, Western HospItal - a ChIld and Adolescent npatIent |ental Health
facIlIty. f you would lIke to express an Interest In a rotatIon at thIs sIte please tIck the box below.


Foyal ChIldren's HospItal ntegrated |ental Health ServIce
(8anksIa UnIt, Western HospItal)


CFA0UATE PSYCHATFC NUFSE PFDCFA| 2012
CLINICAL PLACEhENT PPEFEPENCE FDPh
Graduate Psychiatric Nurse Program
2012


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8. WHEPE 0I0 YDU FIPST LEAPN ADUT THIS PPDCPAh!
. Colleague . WebsIte . NursIng Expo . Dn ClInIcal Placement
. Lecturer . UnIversIty vIsIt by our staff . Dther
9. 0DCUhENTATIDN CHECKLIST
8elow Is a lIst of documents requIred In support of your applIcatIon. Please tIck the relevant boxes to IndIcate
documents attached. PLEASE NDTE: ApplIcatIons cannot be processed unless all documentatIon Is provIded.

ApplIcatIon Form correctly completed
CoverIng letter of applIcatIon
Fesum
Three referees nomInated (clInIcal, academIc, employer)
CertIfIed copy* of academIc transcrIpt most recent (gradIng system codes are provIded)
CertIfIed copy* Year 2 E J ClInIcal evaluatIons (med/surg E psychIatry)
Completed ClInIcal Preference Form
10. 0ECLAPATIDN
acknowledge that thIs applIcatIon Is submItted and receIved on the understandIng that NorthWestern |ental Health
may obtaIn offIcIal records wIth respect to me from any other InstItutIon currently or prevIously attended by me or
from my current employment agency.

declare that to the best of my knowledge the InformatIon supplIed hereIn Is current and complete. acknowledge
that the provIsIon of Incorrect InformatIon or the wIthholdIng of relevant InformatIon relatIng to my applIcatIon may
result In the wIthdrawal by NorthWestern |ental Health of any place that may be offered.


SIgnature of appIIcant: __________________________ 0ate: __________________



Please send your applIcatIon to:
Craduate PsychIatrIc Nurse Program CoordInator
NorthWestern |ental Health
F|H Foyal Park Campus
8uIldIng 5
J454 Poplar Foad
ParkvIlle 7Ic J052


nquIrIes to Sherry WrIght Tel: (0J) 8J87 27J0 or emaIl: [email protected]