General Application Form


Vitae needs to gather sufficient information from you to allow us to assess your suitability for the role.

Please complete the application form below. When you have completed your responses, please click on submit and make sure your application is acknowledged on screen.

Please be assured the information collected is confidential to Vitae.

Please fill in the following form.

First Name*
Last Name*
Email Address:*
Home Phone:
Work phone*
Mobile Phone:*
Practice Address (primary)*
Position Applied for:*
Please describe your general availability for service delivery*
Geographical Regions covered *
Practice Address 2 (if working from more than one location)
Qualifications *
Annual practicing certificate expiration (if applicable):
Professional Memberships/Registration:*
Please confirm that you are willing to submit to a NZ Police vetting check?* 
Experience in other languages *
Sectors in which you have experience e.g. health, early childhood, management, kaupapa Maori*
Please describe any training in assessments*
Can you respond to clients by phone in 24hr* 
Can you see urgent referals if required* 
Please describe your experience with Critical Incidents *
Have you had a professional practice complaint against you?* 
If so what action was taken ?
Do you have professional indemnity Insurance? (Name of insurer and value of cover)
Do you recieve Clincial Supervison? How often?
Supervisors Name and contact details
Referee (Personal)*
Referee Contact Details*
Referee 2 (Professional - skills)*
Referee 2 Contact Details*
Referee 3 (Direct Report) *
Referee 3 Contact Details
Do you work for any other EAP providers? (Please give details)
Other comments:
How did you find out about us*
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