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Referral
Employment Form
Contact
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Home
About
Services
Referral
Employment Form
Contact
X
0491 605 612
Pre Employment Collection Form
You can read our Pre-Employment Collection Statement
here
.
Preferred nature of employment:
Full time
Part time
Casual
Preferred title:
Mr
Mrs
Miss
Ms
Other
Surname
First name
Residential Address
State
Postcode
E-mail address:
Work Ph:
Home Ph:
Mobile Ph:
If a non-resident, do you hold a current Australian work permit?
Yes
No
Do you have a current drivers licence?
Yes
No
Licence Number
Do you have a current NDIS Worker Screening Check?
Yes
No
Set out your training and qualifications such as:
Do you have any training to assist in the response to an emergency or disaster (such as contingency planning or infection prevention or control)
When could you commence employment?
Details of Secondary employment (if applicable)
Do you identify as:
Aboriginal / Torres Strait Islander
Australian South Sea Islander
Pacific Islander
Other
If other, please specify
In the past 10 years, have you been convicted by a court of any criminal offence or are you currently the subject of a charge pending before any court which could impact on your employment with this organisation?
Yes
No
If yes, please give details. You do not need to give details of any conviction that has been declared spent pursuant to relevant spent convictions legislation.
Do you know of any medical reason why, if appointed, you would be unable to carry out the full requirements of the position?
Yes
No
If yes, please give details:
What reasonable actions could the organisation take to assist you perform the job?
In accordance with the state and Commonwealth legislation all staff and volunteers of this organisation will undertake Criminal History Screening.
I declare that to the best of my knowledge the information given in this application cover sheet, my written application/resume and any accompanying documents is true and correct. I understand that any false or misleading information (including in relation to medical capacity to carry out the full requirements of the position) may render my contract of employment, if I am appointed, liable to termination or give rise to some other disciplinary action.
I consent to and understand that my employment is conditional upon:
● reference checks being conducted to support this application;
● undertaking a pre-employment medical examination, if required, with a medical practitioner designated by the organisation and at its expense;
● psychological or aptitude testing, if required, prior to or following appointment.
Submit
