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Please fill in the below table, all fields marked (*) must be filled.
Clinical years of experience *
Days off/ available to work *
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I declare I am a qualified Registered Nurse/Enrolled Nurse/Assistant in Nursing/Clinical Nurse/other as specified above
I have carefully read and understood all aspects of the terms and conditions *
I understand that I will be required to provide credit shall documents upon request or, else this registration form will not be processed *