Section 1: Candidate details

As the nominating Course Director, we ask that you answer each question. We would like to know about the candidate's most recent attendance on a NZ Resuscitation Council CORE Advanced course, their professional qualification in healthcare, and their practical involvement with clinical resuscitation over the past three years.
This form must be submitted within four weeks of the candidate's provider course.

Question Title

* 1. I am:

Question Title

* 2. I nominate:

Question Title

* 3. The candidate successfully completed their CORE Advanced provider course on:
(This date will be validated against course participant sheets)

Date

Question Title

* 4. The candidate has the following health professional qualification:

Question Title

* 5. The candidate is currently employed as:

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