Register as a Nurse
Trained Overseas - International Medical Graduate


Personal/Contact Details
Last/Family name:
First name:
Preferred name:
Date of Birth (not compulsory):
Gender:
female male
Telephone (home):
Telephone (work):
Telephone (mobile):
Fax:
Current Residential Address:
Current Postal Address:
Email address:
Country of Citizenship:
Is this the country you work and reside in?
yes no
Which country do you work in, if different to your country of residence?
Are you considering coming to Australia with family? If so please list all names and dates of birth (for Immigration purposes) and their relationship to you:
Do you or any family member coming with you have a health problem that may affect the visa?
yes no
Please indicate your preferred method of contact:
Tel (home)  Tel (work)  Tel (mobile)  Fax   Email
Qualification Details
Where did you undertake your primary qualification?
Primary qualification type (eg. Hospital based or which university):
Year of qualification:
Are you currently working?
yes no
Current country that you are (or have been) registered in:
Have you been registered in any other country?
yes no
Have you ever had disciplinary action taken against you by any nursing board in the world?
yes no
Have you applied to the Australian Nursing Council?
yes no
Have you applied to the Nurses Board in the state you are looking to work in?
yes no
If so, for which dates did you apply to the Nurses Board?
Work History
How many years General Practice experience have you had, and in which countries?
Years Country
Have you worked or been registered in Australia? If so - please provide details:
Current State you are registered in:
Please indicate the status of your visa, including your current sponsor if you hold a temporary visa:
Work Preferences
State you would like to work in:
City/Country area you would like to work in:
Duration of stay:
When are you intending to start?
Referral
How did your hear about us?
If applicable, name of AGPR Rewards member: