v

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APPLICATION FORM
For overseas qualied social worker or overseas
social workers resident in New Zealand for less
than 12 months
O/S7 SWRB Application Form 2014
Write your name
on the back of ONE
passport-sized
photograph and
paperclip here
APPLICATION FORM
For overseas qualied social worker or overseas social workers
resident in New Zealand for less than 12 month

1. IDENTIFICATION See Guide Note 1
Family name:
Given name/First name(s): Middle name(s):
Other name/Previously used name(s):
Attach certied evidence if the above names differ from those on your birth certicate, and indicate the reason by
ticking the relevant box below.
Marriage Civil Union Deed poll Common use (provide statutory declaration)
Gender: (please tick) Male Female
Birthplace:
(town and country as shown on your birth certicate/passport)
Birth date: (day/month/year) Ethnicity:

ALL APPLICANTS
Attach certied copy of your birth certicate
Attach certied copy of the relevant identication page(s) of your passport
2. DECLARATION See Guide Note 2
I, ______________________________________________________ (Solicitor / Court Registrar / Justice of the Peace /
Gazetted Ofcer*) certify that I have compared the photograph of
_______________________________________________________ (applicant) before me, and that in my opinion it is a true
and faithful likeness. I am satised that the applicant before me is the person to whom the passport relates.
Signature of certifying authority: ______________________________________ Stamp:
Date:
Please also provide contact details:
Address:
Phone: Email:
*The same legal professional who signs this Declaration must also certify the copy of your passport.
OFFICE USE ONLY
#
1 O/S7 SWRB Application Form 2014
O/S7 SWRB Application Form 2014
3. ADDRESSES See Guide Note 3
HOME ADDRESS
For ofce use only will not be published
Address:
Postcode:
Phone: (+ international code)
Email:
MAILING ADDRESS
If your mailing address differs from your home address, please give details below.
Address:
Postcode:
Phone: (+ international code)
Email:
NEW ZEALAND ADDRESS IF AVAILABLE
Address:
Postcode:
Phone: (+ international code)
Email:
4. QUALIFICATIONS See Guide Note 4
Part A Overseas social work qualications
Attach certied copy of your primary social work qualication (and certied translation if not in English)
Attach certied copy of your ofcial academic transcript (and certied translation if not in English)
Attach copy of SWRB Non-binding Assessment Outcome (if undertaken)
What is your primary social work qualication?
Which education institution provided this qualication?
In what year did you complete this qualication?
What was the usual entry requirement for the qualication?
What was the normal length of the qualication if you studied full-time?
2
Part B Fieldwork / Practicum See Guide Note 5
First eldwork placement
Name of agency:
Nature of work undertaken by agency:
Duties undertaken during placement:
Total number of days: Year completed:
Second eldwork placement
Name of agency:
Nature of work undertaken by agency:
Duties undertaken during placement:
Total number of days: Year completed:
Third eldwork placement
Name of agency:
Nature of work undertaken by agency:
Duties undertaken during placement:
Total number of days: Year completed:
5. COMPETENCE IN ENGLISH See Guide Note 6
Is English one of your rst languages?
Yes (if you ticked Yes, go to question no 6)
No (if you ticked No, please answer the questions in this section)
What is your primary spoken language?
Was your secondary schooling completed in English? Yes No
Was your social work qualication completed in English?

Yes No
I have asked the testing authority to send my IELTS results to the SWRB
O/S7 SWRB Application Form 2014 3
6. CURRENT OVERSEAS LICENCE AND/OR REGISTRATION IN SOCIAL WORK
See Guide Note 7
Do you have or have you previously had any social work registration(s) and/or licence(s) in other countries?
No
Yes attach certied copies of most recent registration certicate(s)/licence certicate(s)
7. COMPETENCE See Guide Note 8
Attach SWRB paper-based overseas competence assessment application
8. CONFIRMATION OF CHARACTER See Guide Note 9
Yes, I have sent the Condential Reference Request form to a referee who meets the criteria outlined in Guide
Note 9
Professional disciplinary proceedings See Guide Note 10
Are you now (or have you ever been) the subject of any professional disciplinary proceedings?
Yes write to the SWRB Registrar explaining the circumstances and enclose in a sealed envelope with your
application
No
Are you currently under investigation for any matter that may become the subject of professional disciplinary
proceedings?
Yes write to the SWRB Registrar explaining the circumstances and enclose in a sealed envelope with your
application
No
If you are, or have been, registered or licensed in in any profession, have you been subject to:
conditions on your registration/licence

Yes No
conditions on your annual licence/practising certifcate Yes No
refusal by a registering or licensing authority to issue a practising certifcate Yes No
If you replied yes to any of the above, write to the SWRB Registrar explaining the circumstances and enclose in a
sealed envelope with your application.
9. CURRICULUM VITAE See Guide Note 11
Attach copy of curriculum vitae (detailing work and education history for the past 10 years)
O/S7 SWRB Application Form 2014 4
10. FIT AND PROPER CRITERIA
The SWRB is required to determine whether you are t to be recognised to practise social work in New Zealand.
Police check See Guide Note 12
Attach a current Police Certicates from any overseas countries you have lived in for twelve months or more in the
last ten years whether on one or more visit
Convictions / Court orders See Guide Note 13
Have you ever been convicted by any court, of any offence or are you currently under investigation for any offence?
Yes write to the SWRB Registrar explaining the circumstances and enclose in a sealed envelope with your
application
No
Are you currently or have you ever been a respondent for a protection order, restraining order, or trespass order?
Yes write to the SWRB Registrar explaining the circumstances and enclose in a sealed envelope with your
application
No
Mental, physical or social condition See Guide Note 14
Are you affected by a mental, physical or social condition which may affect your ability to perform professional social
work?
Yes write to the SWRB Registrar and include any relevant medical reports or evidence from a practitioner as
appropriate. Enclose in a sealed envelope with your application.
No
11. APPLICATION FEE AND PAYMENT See Guide Note 15
Application fee is $368 New Zealand Dollars
I enclose a cheque / Bank cheque made payable to: The Social Workers Registration Board
Please debit my

MasterCard

Visa
Card number: Expiry: /
Name on card:
Signature: Date:
I have paid by direct credit / internet banking with my initials and surname as the reference and NEWAPP as the
code. (Please note that not including the reference and code may delay your application being processed.)
Social Workers Registration Board Bank Account Number: ANZ Bank: 06 0507 0040722 00
Payment Date:
O/S7 SWRB Application Form 2014 5
12. DECLARATION AND SIGNATURE See Guide Note 16
I hereby certify that I am the person who is applying for registration as a social worker in New Zealand, that I am the person
named in the above application, and that the information I have given above is true and correct.
I understand that the information that I have provided is to be used by the Social Workers Registration Board and its agents for
the purposes of considering my application and may be disclosed to agents of the Board for these purposes. I intend to live and
practise social work in New Zealand.
I understand that the Board is authorised to obtain further information from me or any person or organisation concerning this
application under the Social Workers Registration Act 2003 and consent to the collection of such information by the Board
or its agents. I further understand that although the provision of any information by me is voluntary, if I refuse to provide any
information this may affect the Boards consideration of my application.
I understand that I am entitled to access the information held by the Board regarding this application by a request in writing to
the SWRB Registrar, unless condentiality has been requested by the provider of any of this information and that I may request
correction of any information which is not correct.
I understand that conrmation of registration from the Social Workers Registration Board is necessary before I am permitted to
refer to myself as a Registered Social Worker in New Zealand.
I understand that before I am permitted to commence practice as a Registered Social Worker in New Zealand I must be
granted an Annual Practising Certicate from the Social Workers Registration Board.
I undertake to inform myself on my responsibilities as a Registered Social Worker in New Zealand and agree to abide by the
established Code of Conduct for Registered Social Workers in New Zealand.
Applicants signature: Date:
COMPLETED YOUR APPLICATION?
WHAT HAPPENS NEXT?
Thank you for your application for registration as a social worker in New Zealand.
Once we have received your application you will be sent an acknowledgment.
If aspects of your application are incomplete, or documents are missing, we will contact you to request the relevant
information.
When your application is complete and assessed it will be considered at the next scheduled Board Meeting. The
Board meets monthly to approve registrations.
If not already in New Zealand, when you arrive notify the Board of your contact details.
All Registered Social Workers practising in New Zealand are required by the legislation to hold a current Annual
Practising Certicate.
The SWRB nancial year is 1 July 30 June. Your application fee includes the Annual Practising Certicate fee through
to the end of the nancial year in which you apply.
O/S7 SWRB Application Form 2014 6
SWRB APPLICATION FORM 2013 2014 6
CHECK LIST
IMPORTANT NOTE: PLEASE CHECK THAT YOU HAVE ATTACHED ALL THE FOLLOWING
RELEVANT DOCUMENTS WITH YOUR APPLICATION. PLEASE READ THE ACCOMPANYING
GUIDE NOTES BEFORE YOU COMPLETE THIS FORM, THEN REFER TO THE RELEVANT NOTE AS
YOU WORK THROUGH EACH PART.
PLEASE DO NOT SEND ORIGINALS; SEND CERTIFIED PHOTOCOPIES ONLY
One passport-sized photograph, with your name on the back and signed by the person who lls in the declaration
of your application
Certied copy of your birth certicate
Certied evidence of a change of name (if applicable)
Certied copy of the relevant identication page(s) of your passport
OVERSEAS SOCIAL WORK QUALIFICATION:
Certied copy of your primary social work qualication (and certied translation if not in English)
Certied copy of your ofcial academic transcript (and certied translation if not in English)
Copy of SWRB Non-binding Assessment Outcome (if undertaken)
Copies of registration certicate(s)/licence certicate(s), if you have any current or previous social work
registration(s) and/or licence(s) in other countries
Overseas competence assessment application
Police Certicates from any relevant overseas countries
Curriculum vitae
Application fee
PLEASE NOTE THAT THE SWRB CANNOT RETURN ANY ACCOMPANYING DOCUMENTATION
Please mail your complete application and relevant documents to:
SOCIAL WORKERS REGISTRATION BOARD
PO Box 3452
Wellington Central
Wellington 6140
www.swrb.govt.nz
SWRB CONFIDENTIAL REFERENCE REQUEST 2013 2014
CONFIDENTIAL REFERENCE REQUEST
Dear Referee
Applicant name: Date of birth:
has applied for registration as a Social Worker in New Zealand.
Under the Social Workers Registration Act 2003 the Social Workers Registration Board has to satisfy itself
that an applicant is a t and proper person to be registered as a social worker.
To assist the Board would you kindly write a character reference for the applicant covering the following
matters:
How long and in what circumstances have you known the applicant?
Your knowledge of their social work practice.
What reasons relating to character, integrity, reliability and diligence, in your opinion, make the applicant
suitable for registration as a social worker?
Whether there are any factors known to you that would or might be considered to make the applicant
unsuitable for registration as a Registered Social Worker.
To your knowledge, whether the applicant has ever been convicted of an offence.
Please include your full contact details.
It is Social Workers Registration Board policy to accept only original, signed and dated references.
It would be appreciated if you would please quote the applicants full name and date of birth (as per the top
of this form) and then forward the completed original reference to:
SOCIAL WORKERS
REGISTRATION BOARD
PO Box 3452
Wellington 6140
New Zealand
Thank you for your assistance.
Sean McKinley
Registrar
13/14
DD/ MM/ YYYY
1

Guide notes
IMPORTANT NOTE: PLEASE READ THESE NOTES BEFORE COMPLETING THE APPLICATION
FORM, THEN REFER TO THE RELEVANT NOTE AS YOU WORK THROUGH EACH PART.
Certication of a document refers to a copy of an original document that has been certifed as a true copy of the original by a
legal practitioner or person legally authorised to notarise or certify the authenticity of copies of documents in either new Zealand
or an applicants country of origin. each page of the document(s) must be signed and dated.
All documents not in English must be offcially translated unless otherwise specifed. A certifed copy of both the original and
english translation of each document must be included with the application form.
Guide Note 1 IDENTIFICATION
Please attach one passport-sized photograph of yourself with your name on the back.
if your name has changed from that shown on your birth certifcate, please attach certifed copies of any relevant name change
documents.
Guide Note 2 DECLARATION
Please get a solicitor, Court Registrar, Justice of the Peace, or Gazetted offcer to complete and sign this part of your application.
this confrms your identity.
IMPORTANT NOTE: the person who signs this part of your application must also certify the copy of your passport.
Guide Note 3 ADDRESSES
Please supply your home, mailing, and new Zealand address if available.
Your home address will be held in confdence by the social Workers Registration Board, and will not be published in the social
Workers Register, pursuant to section 123 and section 135 of the social Workers Registration Act 2003.
if you have a mailing address that is different to your home address, please provide this as well.
Guide Note 4 QUALIFICATIONS Part A Overseas social work qualications
Must be equivalent to a recognised new Zealand qualifcation. Please provide information and supporting certifed documentation
for all social work qualifcations to be considered in this application.
the documentation required includes the following:
A certied copy of your primary social work qualifcation (and certifed translation if not in english). this means all relevant
academic degree/diploma certifcates conferred by an accrediting social work education or training authority. the document
should state the name of the qualifcation, the name of the conferring or accrediting institution and the date of conferralor award.
A certied copy of your offcial academic transcript for your qualifcation (and certifed translation if not in english). A transcript
is an offcial academic document issued by the institution granting the qualifcation. it lists the subjects taken, the marks
obtained in each subject, the year the subjects were taken and the nature and date of any qualifcation conferred.
A copy of the sWRB non-binding Assessment outcome (if undertaken).
Guide Note 5 QUALIFICATIONS Part B Fieldwork/Practicum
Professional social work qualifcations require a certain number of days of feldwork. Fieldwork normally occurs over 2 or 3
placements. Please describe the nature of your feldwork and the length of time spent on each placement.
Guide Note 6 COMPETENCE IN ENGLISH
if you are from a country where the medium of instruction and assessment in secondary schooling and professional education
is not english, you must undertake an international english Language testing systems (ieLts ) test at the ACAdeMiC level and
achieve an overall score of at least 7.0, with a minimum of 7.0 in each band. the test may be taken via the english department of
most universities. Please ask the testing authority to send your ieLts results direct to the sWRB.
Based on the registration and competence applications the Board may request, even if secondary and professional in english, a
further english language test.
o/s7 sWRB Guide notes 2014
o/s7 sWRB Guide notes 2014
Guide Note 7 CURRENT OVERSEAS LICENCE AND/OR REGISTRATION IN SOCIAL WORK
Please attach certied copies of your most recent overseas social work registration(s) and/or licence(s).
Guide Note 8 COMPETENCE
to apply for registration as a social worker in new Zealand you must include with this application an sWRB paper-based overseas
competence assessment application
Guide Note 9 CONFIRMATION OF CHARACTER
the sWRB requires a reference from a person not related to you, nor living in the same household as you, to attest to your
character. they should be:
your current employer, or
someone for whom you have provided contracted services as a social worker, or
your current supervisor And
have known you for at least six months.
Give your referee a copy of the enclosed Confdential Reference Request information sheet. the referee must post the reference
directly to the sWRB offce.
Guide Note 10 Professional disciplinary proceedings
this section relates to your ftness to be registered to practise social work in new Zealand. it enables the Board to determine
whether you are currently, or have previously been, subject to any professional disciplinary actions within any profession (for
example, social worker, nurse, lawyer, psychologist, etc).
Guide Note 11 CURRICULUM VITAE
Please ensure your curriculum vitae (CV) includes details of work and education history for the past 10 years. Please explain any
gaps in your CV (for example, parental leave, travel), and include the following information for all social work positions you have
held:
dates of employment
name of agency
nature of work undertaken by agency
duties undertaken in position
whether full or part-time and hours per week.
Guide Note 12 Police check
You must provide a police certifcate from any country you have lived in for twelve months or more in the last ten years whether
on one or more visits. Please ensure that the police certifcate covers the period you were in those countries.
Guide Note 13 Convictions / Court orders
Please provide details of:
any court convictions you may have, in any country, of any offence
any offences you are currently under investigation for
any protection orders, restraining orders, or trespass orders you are currently, or have been, a respondent for.
Guide Note 14 Mental, physical or social condition
Please describe any medical, psychological, psychiatric or addiction (drugs or alcohol) disorders, physical deterioration due to
injury, disease, degeneration, or social condition which may affect your ability to perform professional social work. enclose
any relevant medical reports or evidence from practitioners as appropriate.
Guide Note 15 APPLICATION FEE AND PAYMENT
Please include the application fee with your registration application form (cheque, MasterCard, Visa or direct credit please do
not send cash).
Guide Note 16 DECLARATION AND SIGNATURE
Please sign and date your completed form to confrm that you have supplied true and correct information, and read and understood
all instructions. Forms that are not signed and dated will not be accepted by the sWRB and will be returned.
IMPORTANT NOTE: YOU MAY ONLY APPLY FOR REGISTRATION IF YOU INTEND TO LIVE OR ARE
CURRENTLY LIVING IN NEW ZEALAND AND INTEND TO PRACTISE SOCIAL WORK.