Cervical Smear Taker Training NZQA Standard 29556 Entry to the Cervical Screening Training is restricted to individuals who meet the following criteria: 1. The applicant is a registered health professional whose scope of practice includes cervical screening such as Medical Practitioner, Nurse Practitioner, Registered or Enrolled Nurse, Midwife. 2. You must have a current New Zealand Practising Certificate. 3. Possess professional/personal indemnity insurance. 4. Have access to an appropriate client base and have ongoing numbers of women who require cervical screening to ensure competency can be maintained. 5. Be supported by a clinical supervisor (during your training) to complete the clinical component of the course.
Application Form (All fields are compulsory) Course Date: ____________________ Location: __________________________________ Full Name:
______________________________________________________________
Ethnicity:
___________________________
Cell: Ph
_________________________ Email:______________________________
Date of Birth: ____________________
Workplace Name and Address ______________________________________________________________________________ ____________________________________________________________________________________ Work Phone:
__________________________
Main area of practice: Registered Nurse Enrolled Nurse
Work email: ________________________________
Midwife Medical Practitioner
Nurse Practitioner
Practicing Certificate #: ……………………………..
S:\Cervical Smear Taker Training 2020\Smeartaker Course Application.doc
Indemnity Insurance #………………………….