$UserDefinedForm

During your first year of practice, you will participate in the Counties Manukau Health (CM Health) Nurse Entry to Practice (NETP) programme. The NETP programme is partly funded by Health Workforce New Zealand (HWNZ) which is part of the Ministry of Health. It is a requirement of HWNZ that CM Health collects the following data, including your result of any postgraduate requirements of the NETP Programme, and will only release it to HWNZ for reporting and auditing purposes and to meet the requirements of the Privacy Act (1993).

This form must be completed by 20/01/2020

IMPORTANT: This form is best viewed in Firefox.

IMPORTANT: You must complete this form in one sitting.

You cannot save the form and return to it. If you would like to outline your answers you can download a copy of this form.

Note: Annual Practising Certificate (APC).

Note: First name as it appears on your APC.

Note: First name as it appears on your APC.

Note: CMDHB employees, type Counties Manukau DHB. Non-CMDHB employees, type your Employer’s name. Do not use abbreviations

Note: Leave spaces between multiple entries. Do not use brackets or commas.

DD/MM/YYYY

Transition/Pre-registration Placement

NETP Employment 

Note: Name of ward, unit, etc.

Applicant Agreement

Do you agree to the following terms?

  • • CM Health can release this information to HWNZ for reporting and auditing purposes in accordance with the Privacy Act (1993).
  • • The university/technical institute can inform the NETP coordinator and/or educator if it appears you are struggling to meet the assessment criteria so that additional support can be initiated if required.
  • • CM Health can seek confirmation of course completion and results from the university/technical institute involved.

Last modified: