Employment Application Form

Date:

Title:

Surname:

First:

Preferred name:

Date of birth:

Residential address:

Postal address:

Email:

Phone:

Mobile:

Residential Status: Australian Citizen?:

Permanent Resident?

Working Visa?

Student Visa?

If yes, please state the type:

Do you have a current First Aid Certificate?

National Police Check?

Do you have any previous Police convictions?

If yes, please comment

Do you have a current working with children's card (OCHRE card)?

Current Australian Driver’s License?

Do you have your own transport?

Name:

Phone:

Address:

Comments:

Please list, Secondary/Tertiary qualifications, the School/University and location, level(s) achieved and date(s) completed. List from most recent.

Please list employment history including employer/organisation, period of employment, position/title held, and duties performed. List from most recent.

a) Do you have any physical or medical conditions that may affect your ability to carry out the duties of this position? If so please give details (Please answer each question)

b) Have you previously taken or are you currently taking medication that could affect your work performance in line with the relevant duties and responsibilities?

c) Have you ever sustained an injury previously that may affect your ability to carry out the duties of this position?

d) Do you have any of the following that could affect your work performance in line with the relevant duties and responsibilities?

e) Will you agree to undergo a medical examination for work suitability if requested?

Files:

Declare:

Applicant Signature:

Date: