Duty of Disclosure

Duty of Disclosure

Please fill out the following form to submit your Duty of Disclosure form as part of the registration process.

Your Details


Title:

Fitness to Undertake Work

Do you have any criminal convictions, or actions pending which could result in a criminal conviction in New Zealand or overseas and/or are you aware of any matters pending?
yesno

Has any Medical Board/ Council imposed any limitations on your medical Registration?
yesno

Have you ever been under investigation by an employer for performance or conduct issues? Or had your scope of practise limited by an employer or regulatory authority?
yesno

I have read and agree to the terms of the Privacy Policy: