Nursing Apply Now

Student's Name* Father's Name:* Mother's Name:*

PRESENT ADDRESS*

House Number PO: District

Road Number Thana: Postal Code

PERMANENT ADDRESS*

House Number PO: District

Road Number Thana: Postal Code

Student's Mobile No* Student's Email*

First Guardian Mobile Number*

Relationship with First Guardian*

Date of Birth* Place of Birth* Gender* Blood Group* Religion* Passport Number* Passport Issue Date* Passport Expiry Date* Nationality* National ID*

EDUCATIONAL QUALIFICATION :

SSC/ O LEVEL * :

Year of Exam* Board*

Name of Institute* GPA*

HSC/ A LEVEL :

Year of Exam Board

Name of Institute: GPA

BACHELOR :

Year of Exam Board/City

Name of Institute CGPA

MASTERS :

Year of Exam Board/City

Name of Institute CGPA:

TRAINING ON NURSING :

Year of Exam Board/City

Name of Institute Result:

Experience of Nursing*

SELECT YOUR SUB-AGENT

Select Your Sub-Agent*

DECLARATION:

Have you ever been convicted by any court of law whether in Singapore or elsewhere, of any offences?* Have you ever been the subject of adverse finding(s) in proceedings before any professional body or tribunal whether in Singapore or elsewhere?* Select Your Answer Below* Select Your Answer Below: Select Your Answer Below* Are you currently undergoing psychiatric treatment?* Acceptance 1*

I declare that the particulars stated in this application and the documents attached are true, correct and complete and the information contained herein remains true, correct and coplete to date. I undertake to inform INA of any data discrepancy (e.g inaccurate/outdated data) and I am aware that I may be asked to provide more information to the INA, If necessary. To the best of my knowledge and belief, I have not withheld any material fact.

Acceptance 2*

I acknowledge that the INA reserve all rights to withhold registration or to remove my name from the appropriate register and/or take any action it deems fit. I also understand and give my consent for the INA to make any enquiries or to obtain any information & documents whice it may require to verify my qualifications and fitness to practise.

Acceptance 3*

I acknowledge that the INA reserve all rights to receive, collect and/or tranmit the avove personal data or other authorities or argencies if required to do so for the purpose of carrying out its under the Nurses & Midives Act (NMA) and/or for compliance with any other Acts and subsidary legislations. I also acknowledge that INA is not liable for any damage or loss caused to me in couse of my using the Professional Registration System (PRS) due to data errors in the personal data I provide. The personal data collected will be kept in the strictest confidence and access restricted only to authorised persons. To safegaurd all personal data, all electronic storage and transmission of personal data are secured through appropriate security technology.

Acceptance 4*

I agree to allow this application including all of the information contained, and declarations set out, in this application to be accessed by prospective employer.

Below Mentioned Objectives (attested) must be attached with the application.

Valid Passport Image* Passport Size Photos* Educational Certificates Image* National ID Card/Birth Certificate Image* Training Certificate (If any) Image Please type your name here to certify that all the information on this form is true and correct* Please type the name of your Parent/Guardian here to certify that they are aware and give permission*

APPLICATION FORM

PRESENT ADDRESS*

PERMANENT ADDRESS*

EDUCATIONAL QUALIFICATION :

SSC/ O LEVEL * :

HSC/ A LEVEL :

BACHELOR :

MASTERS :

TRAINING ON NURSING :

SELECT YOUR SUB-AGENT

DECLARATION:

Below Mentioned Objectives (attested) must be attached with the application.