Applicant’s details

Name:*
Are you an Australian Citizen or Permanent Resident?*

Document checklist

ACN student card application form (If you have completed this form, continue to the next document)

National Police Certificate
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Evidence of immunisations and serology for the following: Hepatitis B
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Evidence of immunisations and serology for the following: Measles, Mumps and Rubella
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Evidence of immunisations and serology for the following: Tuberculosis (Mantoux test and chest x-ray)
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Evidence of immunisations and serology for the following: Varicella
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Evidence of immunisations and serology for the following: Diphtheria, Tetanus and Pertussis
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Working with Children Check
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State specific document checklist: Australia Capital Territory

Additional evidence of immunisations and serology for the following: Influenza (annually)
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State specific document checklist: New South Wales

Clinical placement information disclosure form
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NSW Health Code of Conduct Agreement
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Attachment 7
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Attachment 6
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Annual Influenza Vaccination
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Criminal Record Check for international students Or Statutory Declaration Form
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Students who are not Australian citizens nor hold permanent resident status needs to provide a criminal record check from their country of origin and any country they have resided in since the age of 16 or older in additional to their Australian criminal record check for the compulsory NSW Health compliance screening. Alternatively students have to complete a statutory declaration signed in front of a judicial officer declaring that they have no criminal convictions or offences against children in any county prior to entering Australia.
Do you have a criminal history?
NSW Health Clinical Placement Authority Card, or conditional letter issued by NSW Health^
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^for students with criminal history only

State specific document checklist: Northern Territory

Additional evidence of immunisations and serology for the following: Polio
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Additional evidence of immunisations and serology for the following: Influenza (annually)
No File Chosen
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Additional evidence of immunisations and serology for the following: Hepatitis A
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Annual CPR competency
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• Current First Aid certificate
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• Hand hygiene certificate
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Department of Health privacy policy
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State specific document checklist: Queensland

Student orientation checklist
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Student deed poll (group A)
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Are you a RN?
Blue card (exception for RN)
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State specific document checklist: Western Australia

Additional evidence of immunisations and serology for the following: Influenza (annually)
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State specific document checklist: South Australia

Aged care checks, child related employment screening, and Vulnerable Person Related Employment from DCSI
No File Chosen
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Additional evidence of immunisations and serology for the following: Polio
No File Chosen
File uploads may not work on some mobile devices.
Additional evidence of immunisations and serology for the following: Influenza (annually)
No File Chosen
File uploads may not work on some mobile devices.
Additional evidence of immunisations and serology for the following: Hepatitis A
No File Chosen
File uploads may not work on some mobile devices.
Additional evidence of immunisations and serology for the following: Hepatitis C
No File Chosen
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Clinical placement deed poll
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State specific document checklist: Victoria

Additional evidence of immunisations and serology for the following: Hepatitis A
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File uploads may not work on some mobile devices.
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