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Home Training School of Nursing Application Form

Nursing Application Form

You will receive an email from us confirming our receipt of your application shortly. This confirmation email will be sent to your personal email address you have listed below. If you do not receive confirmation please notify us at the following email --- schoolofnursing@hsa.ky.

* indicates required information.
Personal
Surname/ Last Name:*
First Name:*
Middle Name:
Postal Address:*
Permanent Address:*
Date Of Birth (dd-mm-yyyy):*
Age:
Place of Birth:*
Home Phone Number:
Work Phone Number:
Email:*
Nationality:*
Photo:*
(Only jpg,jpeg,gif formats are allowed here.)
Security Code:	Enter the sum of 3 and 4.
Dependants
Marital Status	Single Married Divorced
	Separated Widowed
Religious Denomination/Affiliation:
Number of Dependants:
Date Of Birth (YYYY-MM-DD):
Relationship:
How many are with you?
How many will be joining you later?

What is your Immigration Status in the Cayman Islands?
(e.g. Caymanian, Work Permit Holder/Dependant of Government Employee/Student/Resident)
Do you possess Caymanian Status?	Yes No
If YES, please give the date of issue (dd-mm-yyyy):
Upload a copy of the status documents:
(Only pdf, doc, xsl formats are allowed here.)
If NO, are you married to a Caymanian?	Yes No
Has an employer ever been denied a Work Permit for you?	Yes No
Have you ever worked for the Cayman Islands Health Services Department/Authority?	Yes No
If YES, in which section?
(Please state reason for leaving.)
Do you have any relatives working for the Cayman Islands Health Services Department/Authority?	Yes No
If YES, please state their names, relationship to you and the departments in which they work

Do you have a valid driver’s license?	Yes No
Do you own or have access to transportation during and after working hours?	Yes No
Complete Record of Education from Age 13
Schools/ From/ To/ List all external exams taken and subjects (e.g. GCE/CXC) studied or passed, with grades or certificates obtained. SAT or ACT score:
Universities/ From/ To/ List all external exams taken and subjects (e.g. GCE/CXC) studied or passed, with grades or certificates obtained. SAT or ACT score:
Other technical training / professional qualification gained or being studied/ From/ To/ List all external exams taken and subjects (e.g. GCE/CXC) studied or passed, with grades or certificates obtained. SAT or ACT score:
Previous Employment
May we contact any of your previous employers?	Yes No
If YES, please give the name of the person to contact.
1. Person to contact:
Company Name:
Address:
Telephone:
Best Time to Call:
2. Person to Contact
Company Name:
Address:
Telephone:
Best Time to Call:
Please explain your reason for choosing Nursing as a career at this time.
Or you can upload your explanation as a document here:
(Only pdf,doc,xls formats are allowed here)
Additional Information
Do you have any health problems or disabilities?	Yes No
If YES, please give details:
Hobbies, sports, extra-curricular activities:
Next of Kin:
Relationship:
Address:
Telephone Numbers of Next of Kin:
Home:
Work:
If selected when you could start training?

If you have been convicted of a criminal offence, please submit the full details of the conviction in a sealed envelope to the School of Nursing office. The envelope will only be opened and read by the Health Services Authority if you are to be considered for training.
NOTE: Failure to disclose relevant details or giving misleading information will cause your application to be rejected or if you are appointed it could lead to termination of training.

Home Training School of Nursing Application Form

Nursing Application Form

Personal

Dependants

Complete Record of Education from Age 13

Previous Employment

Additional Information