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Job Application: Registered Health Clinician – Child and Adolescent Mental Health Services, Whangārei (AH22-258)

Northland District Health Board has established a set of values by which the organisation will respond, in part, to achieving its goals and objectives through their workforce. The following Values are expected behaviours of each individual employed with NDHB:

Values Supporting Statement
People First
Tangata i the tuatahi
People are central to all we do
Whakaute (tuku mana)
We treat others as we would like to be treated
We nurture those around us, and treat all with dignity and compassion
Whakawhitiwhiti korero
We communicate safely, openly and with respect to promote clear understanding
Taumata teitei (hirangi)
Our attitude of excellence inspires success, competence, confidence and innovation

The completion of this form does not indicate there is an obligation on Northland District Health Board to engage the applicant. This information is collected for the purpose of assessing your suitability for employment at Northland District Health Board, which may include subsequent changes in your employment with Northland District Health Board. Required fields are indicated with an asterisk (*).

Please note, if short-listed for an interview, evidence of entitlement to work in New Zealand will be required from both New Zealand citizens and non-New Zealanders in accordance with the Immigration Act (2009).

Northland DHB has a responsibility to minimise the risk of harm to patients, clients and staff from preventable diseases. Potential new employees are subject to occupational health clearance, which includes being able to prove or obtain immunity from preventable diseases. Any offer of employment will be subject to satisfactory occupational health clearance.

Personal details
Please select an address from the drop down after you start typing, or alternatively click on enter address manually.
My postal address is different to this address
Please fill in at least 1 contact number field.

For statistical reporting purposes we are asking you to answer the following question. This information is NOT used in the evaluation of your application, it is for statistical purposes only.

Please would you state which ethnic group you best identify with? (You must answer this question but you may choose not to reveal your ethnicity if you wish)
Note: An ethnic group or ethnicity is a category of people who identify with each other based on common language, ancestral, social, cultural, or national experiences.

Professional Qualifications: Registered Health Clinician
Education Qualifications
Current Employer
Previous Employment
Other Relevant Details
Curriculum Vitae & other Supporting Documents

'Select Files' from your computer to accompany your application.
Once finished selecting files (you can remove files before uploading) click the 'Upload Files' link below to attach the files to your application.

Allowed formats: .pdf .doc .docx & .txt.
Maximum filesize of 2MB each.

I consent to Northland District Health Board seeking verbal or written information on a confidential basis about me from representatives of my previous/current employers and or referees, and authorise the information sought to be released by them to Northland District Health Board for the purposes of ascertaining my suitability for the position I am applying for.*

Please note, three references are required and at least one referee should be from your present employer and one referee should be from a previous employer.*

Please fill in at least 1 contact number field.
Please fill in at least 1 contact number field.
Please fill in at least 1 contact number field.
I declare that to the best of my knowledge the answers provided in this application form and any other information provided to Northland District Health Board in support of my application is correct and I understand that if any false or deliberate misleading information is given, or any material suppressed, I will not be accepted, or if I am employed, my employment may be terminated. I also understand that any false information given in relation to my medical history with regard to gradual process, disease or infection can result in my loss of entitlement to any accident compensation.*

Date of application 28/09/2022 15:13, submitted by IP address:

Data Retention Declaration
The information that you provide to Northland District Health Board (NDHB) is used for recruitment purposes. Northland DHB staff involved in the recruitment process will be given access to this information.

Data retention
We keep your information for the time period required to complete the purposes for which it is processed or satisfy legal retention requirements. The length of time for which we retain information depends on the purposes for which we collected and use it or the requirements of the applicable laws.
If our processing of your data is covered by European data protection law (GDPR - General Data Protection Regulation), you have certain rights including:
  • You can request access and review information your information at any time
  • You have a right to correct your personal data
  • You can ask that we stop using your information
  • You have the right to request that your information is erased
  • You have the right to withdraw consent

We undertake to keep your information safe to the best of our ability by maintaining the integrity/security of systems on which your data is kept.
If you have any questions about our dealings regarding your Personal Information including any breaches by us of any privacy laws or any questions regarding this Privacy Statement you are able to submit that complaint or query by contacting us at

Any complaints received by us will be referred to Human Resources and a response will be provided to you as soon as possible.

For more information about privacy issues in New Zealand and protecting your privacy, visit the New Zealand Privacy Commissioner's website.

By my Accepting below, I certify that I have read, fully understand and accept all terms of the foregoing statement.

I Accept.*