New Zealand RN Registration Assessment Form

Education History (Local and/or International)
School and Location
Course
Date Completed
High School
High School Location
High School Course
Month / Year
Vocational
Vocational School Location
Vocation Course
Vocational Date Completed
College
College School Location
College Course
College Completed
Post Graduate
Post Graduate School Location
Post Graduate Course
Post Graduate Date Completed
Work Experience (Please list ALL employment - local or abroad, business or volunteer work)
Date from (dd/mm/yy)
Date to (dd/mm/yy)
Company Name & Location
Position Held
Date From 1
Date To 1
Company and Location
Position Held
Date From 2
Date To 2
Company and Location
Position Held
Date From 3
Date To 3
Company and Location
Position Held
Date From 4
Date To 4
Company and Location
Position Held
Date From 5
Date To 5
Company and Location
Position Held
PRC Registered (If applicable)*
- Yes
- No
License no.
English Language Test
English Language Test - None
- None
Target Date of Test
IELTS
- a. IELTS
b. Others
No. of IELTS test taken:
Date of Test Result
Reading
Writing
Listening
Speaking
Overall Score

Partner's Details
Name
Family Name First Name/s Middle Name
Date of Birth*
Age
Gender
- Male
- Female
Partner's Qualification
Highest Educational Attainment
Course
School and Location
Date Completed
Present Work
Company & Location
Years of relevant work experience
Dependent Children (18 years old & below)
Name
Age
Dependent Name
Dependet Age
Dependent Name
Dependent Age
Dependent Name
Dependent Age
3A Do you have friends, relatives, or contacts in your target country?
- Yes
- No
Please indicate below.
Name
Address
Relationship
Relative's Name
Relative's Address
Relative's Relationship
Relative's Name
Relative's Address
Relative's Relationship
Relative's Name
Relative's Address
Relative's Relationship

Your Personal Details