SINGAPORE NURSING BOARD

APPLICATION FOR REGISTRATION/ ENROLMENT

REGISTRATION DETAILS

Recent
Passport-sized
Photograph

1. TYPE OF REGISTER /ROLL

 Registered Nurse  Registered Nurse (Psychiatric)
 Registered Midwife  Enrolled Nurse
2. TYPE OF APPLICATION
 New Application for Registration/Enrolment
 Temporary Registration (HMDP /CAIEP /Nursing Studies /Clinical Practice /Teaching /Research /Voluntary /
Others (Specify) __________________________________________________
3. I am also trained in other healthcare profession: _______________________________________________________

PARTICULARS OF APPLICANT
4. IDENTIFICATION TYPE:
 NRIC  FIN  Passport
5. IDENTIFICATION NO.:

6. SALUTATION:
 Prof  Assistant Prof  Dr
 Sir  Mr  Ms
 Miss  Mdm
7. FULL NAME AS SHOWN IN NRIC/PASSPORT (Please underline surname):

8. NAME IN CHINESE CHARACTERS:

(For Chinese applicant only)

9. GENDER:
 Male  Female
10. RACE:
 Chinese  Eurasian  Indian
 Malay  Others (Specify):____________________________________

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11. DATE OF BIRTH:

Day Month Year

12. NATIONALITY:
 Singaporean  Others (Specify):______________________________
13. COUNTRY/PLACE OF BIRTH:
 Singapore  Others (Specify):______________________________
14. MARITAL STATUS:
 Single  Married  Cohabitated
 Separated  Divorced  Widowed
15. RELIGION:
 Buddhism  Christianity  Free Thinker
 Hinduism  Islam  Sikhism
 Others:_____________________________
16. YEAR OBTAINED CITIZENSHIP (if converted from other nationalities): ___________
17. OTHER NATIONALITY: __________________________
18. RESIDENTIAL STATUS (if not Singapore citizen):
 Singapore Permanent Resident  Employment Pass
 Work Permit  S Pass
 Dependent’s Pass  Others (Specify): ______________________________
YEAR PR OBTAINED (if available): _______________
YEAR EP OBTAINED (if available): _______________
YEAR WP OBTAINED (if available): _______________
19. PREFERRED EMAIL ADDRESS: ______________________________________________________________
20. ALTERNATE EMAIL ADDRESS: ______________________________________________________________
21. HOME TEL NO.: +65 _______________________
22. OFFICE TEL NO.: +65 _______________________
23. MOBILE NO.: +65 _______________________
24. RESIDENTIAL ADDRESS IN SINGAPORE
House / Block Number Level Unit

Street Name

Building Name

Postal Code

25. OTHER SINGAPORE RESIDENTIAL ADDRESS

House / Block Number Level Unit

Street Name

Building Name

Postal Code

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 26. FOREIGN ADDRESS
Country

Address Line 1

Address Line 2

Address Line 3

Address Line 4

Contact No.

27. PREFERRED MAILING ADDRESS

 Residential Address in Singapore  Other Singapore Residential Address
 Foreign Address
28. INFORMATION ON SPOUSE
a. a. FULL NAME AS SHOWN IN NRIC/PASSPORT (Please underline surname):

b. b. NATIONALITY: _______________________________________________________

c. c. OCCUPATION: _______________________________________________________
d. d. If spouse is working in Singapore
Company Name

House / Block Number Level Unit

Street Name

Building Name

Postal Code

e. e. If spouse is a registered healthcare professional in Singapore

SINGAPORE HEALTHCARE PROFESSIONAL ENTITIES
 Singapore Medical Council  Singapore Dental Council
 Singapore Pharmacy Council  Singapore Nursing Board
 Traditional Chinese Medicine Practitioners Board  Optometrists and Opticians Board
 Allied Health Practitioners Board

REGISTRATION NO.: ___________________________

f. f. If Spouse is not a registered healthcare professional in Singapore, does your spouse intend to apply for registration in Singapore?
 Yes  No
If yes, please provide details
_______________________________________________________________________________________________________
_____________________________________________________________________________________

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QUALIFICATIONS AND CLINICAL / PRACTICE EXPERIENCE OF APPLICANT
29. BASIC NURSING /MIDWIFERY QUALIFICATION OBTAINED
a. COUNTRY: ____________________________________________________________________________________

b. UNIVERSITY / INSTITUTION: _____________________________________________________________________

QUALIFICATION TYPE:
c.  Masters Degree  Bachelor’s Degree  Graduate Diploma
 Diploma  Others, pls specify: ____________________________________________
d. QUALIFICATION NAME: _______________________________________________________________________________

e. ABBREVIATION OF QUALIFICATION: _______________________________________________________________

f. SUBJECT AREA / SPECIALTY: ____________________________________________________________________

g. PROGRAMME TYPE: Full-time  Part-time

h. COURSE DURATION: __________ months

i. START DATE (dd/mm/yyyy): ____________________

j. END DATE (dd/mm/yyyy): ____________________

k. YEAR OBTAINED (yyyy): __________

TWINNING PROGRAMME:  Yes  No
l.
If “Yes”, please specify Twinning Partner: ______________________________________________________________

Please complete the following section only if you DID NOT complete your basic qualification in the SAME University / Institution /
Country.
Year Country University / Institution Start Date End Date
(dd/mm/yyyy) (dd/mm/yyyy)
1
m. 2

Please specify the details for gap periods of more than 1 year
Period (dd/mm/yyyy) to (dd/mm/yyyy) Details

n.

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30. Are you required to take a licensing examination before you can practice as a Nurse/ Midwife in the country where you obtained
your primary professional qualification?
 Yes  No
If “Yes”, please provide details
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
31. If licensing examination is required, have you attempted and passed the required examination?
 Yes  No
If “No”, please provide details
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
32. POSTGRADUATE / POST-REGISTRATION NURSING /MIDWIFERY QUALIFICATIONS OBTAINED
Country University / Full Name of Abbreviation of Programme Type Specialty Year Conferred
Institution Qualification Qualification (yyyy)
 Full-time
 Part-time

 Full-time
 Part-time

 Full-time
 Part-time

 Full-time
 Part-time

 Full-time
 Part-time

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33. CLINICAL / HOUSEMANSHIP / INTERNSHIP EXPERIENCE OF APPLICANT
Country University / Department Discipline Start Date End Date Total Clinical
Institution (dd/mm/yyyy) (dd/mm/yyyy) Practice Hours

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34. WORK PRACTICE EXPERIENCE (AS A NURSE/ MIDWIFE)
Date Joined Date Left Country Name of Institution / Department Grade / Type
(dd/mm/yyyy) (dd/mm/yyyy) Organisation Designation /
Appointment
 Full-time
 Part-time, no of hrs
per week:
____________

 Full-time
 Part-time, no of hrs
per week:
____________

 Full-time
 Part-time, no of hrs
per week:
____________

 Full-time
 Part-time, no of hrs
per week:
____________

 Full-time
 Part-time, no of hrs
per week:
____________

 Full-time
 Part-time, no of hrs
per week:
____________

 Full-time
 Part-time, no of hrs
per week:
____________

 Full-time
 Part-time, no of hrs
per week:
____________

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35. Please provide details for gap periods of more than 6 months in your work practice experience, if any.
Period (dd/mm/yyyy) to (dd/mm/yyyy) Details

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36. NURSING / MIDWIFERY REGISTRATION / LICENSING DETAILS (obtained outside Singapore)
Country Council / Registration Registration / Registration Current PC No. Current PC Current PC
Registration Type / Licensing No. Date Start Date End Date
Authority Category (dd/mm/yyyy) (dd/mm/yyyy)

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 EMPLOYMENT DETAILS OF APPLICANT
37. CURRENT (SINGAPORE) EMPLOYMENT DETAILS
a. a. ACTIVITY STATUS:
 Working full-time  Working part-time  Not Working
If “Not Working”, please state the reason:
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________

If “Working part-time”, please state the number of hours per week: ___________
b. b. APPOINTMENT: _________________________________________________________________________________________

c. c. NAME OF INSTITUTION / ORGANISATION: ___________________________________________________________________

NATURE OF WORK:
d. d.
 Clinical  Teaching / Research  Others, specify: ________________________
e. e. DEPARTMENT / DIVISION: ________________________________________________________________________________

f. f. DATE JOINED (dd/mm/yyyy): _________________

g. g. DATE LEFT (dd/mm/yyyy): _________________

38. PROPOSED (SINGAPORE) EMPLOYMENT DETAILS
a. a. APPOINTMENT: _________________________________________________________________________________________

b. b. NAME OF INSTITUTION / ORGANISATION: ___________________________________________________________________

NATURE OF WORK:
c. c.
 Clinical  Teaching / Research  Others, specify: ________________________
d. d. DEPARTMENT / DIVISION: ________________________________________________________________________________

e. e. DATE JOINED (dd/mm/yyyy): _________________

39. PRINCIPAL PLACE OF PRACTICE
a. a. APPOINTMENT: _________________________________________________________________________________________

b. b. NAME OF INSTITUTION / ORGANISATION: ___________________________________________________________________

NATURE OF WORK:
c. c.
 Clinical  Teaching / Research  Others, specify: ________________________
d. d. DEPARTMENT / DIVISION: ________________________________________________________________________________

e. e. DATE JOINED (dd/mm/yyyy): _________________

f. f. DATE LEFT (dd/mm/yyyy): _________________

40. SECONDARY PLACE(S) OF PRACTICE
Appointment Institution / Organisation Nature of Work Department / Division Date Joined Date Left
(dd/mm/yyyy) (dd/mm/yyyy)
 Clinical
 Teaching /
Research
 Others, specify:
__________________

 Clinical
 Teaching /
Research
 Others, specify:
__________________

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DECLARATIONS
41. Have you ever been or are you currently the subject of an inquiry or an investigation by any licensing authority in Singapore or
elsewhere involving an allegation of professional misconduct or improper conduct which brings disrepute to the nursing
profession?
 Yes  No
If “Yes”, please provide full details
__________________________________________________________________________________________________________
__________________________________________________________________________________________________________
__________________________________________________________________________________________________________
42. Have you ever suffered or are you suffering from any physical or mental illness, which impairs your fitness to practice as a
Registered Nurse/ Registered Midwife/ Enrolled Nurse?
 Yes  No
If “Yes”, please provide full details
__________________________________________________________________________________________________________
__________________________________________________________________________________________________________
__________________________________________________________________________________________________________
43. Have you ever been convicted in Singapore or elsewhere of any offence?
 Yes  No
If “Yes”, please provide full details
__________________________________________________________________________________________________________
__________________________________________________________________________________________________________
__________________________________________________________________________________________________________
44. If you are performing Exposure Prone Procedures (EPP), it is MOH's policy that you should know your BBD status due to the risk
of transmission during such procedures. All healthcare workers who have been diagnosed with BBD should declare their status to
their respective Professional Boards/ Councils. Healthcare workers with BBD should not perform EPP.
a) Are you practising any exposure prone procedures (Exposure Prone Procedures (EPP))?
 Yes  No
b) Are you aware that you are a carrier of any blood-borne diseases (BBD) such as Hep B, Hep C or HIV?
 Yes  No
Your current BBD Declaration is different with your past declarations, please provide the reason below.
(To indicate NA if not applicable)
__________________________________________________________________________________________________________
__________________________________________________________________________________________________________
__________________________________________________________________________________________________________
 I declare that I am a carrier of a blood borne disease and hereby acknowledge that I will not perform any exposure-prone
procedure in view of my infected status and the possible risk of transmission to my patients. I will also comply with all applicable
guidelines pertaining to blood-borne diseases as may be issued by the Ministry of Health1 and/or other regulatory agencies as
well as ensure that I am not placed in any situation where there may be a possible risk of transmission to my patients.
 I understand and agree that failing to adhere to the above may result in the cancellation of my registration (on any or all
registers) and practising certificate/s with the Singapore Nursing Board.
1
Please refer to "MOH DIRECTIVE ON MANAGEMENT OF HEALTHCARE WORKERS (MEDICAL, DENTAL, NURSING AND
PARAMEDIC) WITH HEPATITIS B, HEPATITIS C AND HIV"

Applicant’s Name:

Applicant’s Signature & date:

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45.  I declare that the particulars stated in this application and the documents attached are true and authentic, and the information
contained herein remains unchanged to date. To the best of my knowledge and belief, I have not withheld any material fact.

 I acknowledge that the Singapore Nursing Board reserves all rights to withhold and/or to terminate my registration and/or take
any action it deems fit, if any of the above information or documents tendered is found subsequently to be false. I am also aware
that it is a criminal offence to make any false statements, to provide any false information and/or document(s) to the Singapore
Nursing Board. I also understand and give my consent for the Singapore Nursing Board to make any enquiries or obtain any
information & documents that it deems appropriate to establish my fitness to practice.

 I also authorise the Singapore Nursing Board to release the data provided by me, to the Ministry of Health and such other
parties where the Registrar deems essential for the purpose of their official duties under current legislations.

I agree for my employing hospital/institution (to indicate

applicant’s place of practice) to submit my application for registration/enrolment and all my supporting documents on
my behalf (if applicable).

Signature & Date of Applicant Signature & Date of Employer HR/ Nursing Rep

Name of Applicant : Name of Employer :

(As on NRIC/Passport) HR/Nursing Rep
(As on NRIC/Passport)

NRIC / FIN/ Passport : NRIC/ FIN (last 3 digits and :

Number alphabet) OR Employer HR/
Nursing Rep’s Employee
number

Date of Birth : Designation :

(DD/MM/YYYY)

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