Application for Employment

Applicant Details

Title

MrMrsMissMsOther

Do you identify as Aboriginal/Torres Strait Islander? *

YESNO

First Name *

Surname *

Date of Birth *

Country of Birth *

Do you require a Visa to work in Australia? *

YESNO

Please provide a copy of your Visa

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Arrival Date

Type

Email Address *

Mobile *

Home Address *

Suburb *

State *

Postcode *

Copy of current CV *

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Cover letter

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Details of Employment

**Please provide details below ( at least the last 2 positions held )

Position #1

START DATE OF EMPLOYMENT

FINISH DATE OF EMPLOYMENT

COMPANY

POSITION HELD

REASON FOR LEAVING

Position #2

START DATE OF EMPLOYMENT

FINISH DATE OF EMPLOYMENT

COMPANY

POSITION HELD

REASON FOR LEAVING

Do you need to give notice to current employer?

YESNO

How Long?

Do you have any upcoming commitments/pre-booked holidays?

YESNO

Give Details

Do you have a 2nd Employer / Job?

YESNO

Give Details

Referees

** WORK references ONLY (not family members or friends)

Must supply MINIMUM OF TWO names and companies who could speak on your behalf

Referee #1

Company *

Person to contact *

Title *

Business Phone No. *

How long have you known Referee #1? *

Referee #2

Company *

Person to contact *

Title *

How long have you known Referee #2? *

Occupational Licences & Certificates

Drivers Licence

C' Class

LR' Class

MR' Class

HR' Class

MC' Class

Qualifications

Please tick any qualifications you hold *

First AidPerform CPRCert IV DisabilityCert III/IV Aged CareRegistered NurseEnrolled NurseOther

If other, please state

Upload Certificates

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Availability

Please indicate Days you are available, including times. *

Employment type *

ABN - ContractorEmployee - CasualEmployee - Part-time

Preferred Hourly Rate *

Health and Safety / Medical Questionnaire

Please answer the following questions and provide details where applicable.

Have you ever had any injuries that impacted on your ability to perform work? *

YESNO

Year of injury

Nature of injury

Duration of injury

Any restrictions

Clearance date

Year of injury

Nature of injury

Duration of injury

Any restrictions

Clearance date

Hobbies and Interests

Please list any hobbies and interests you have *

Thank you for your application

We will be in touch with you soon to discuss an opportunity to work with

ACT BELIEVE ACHIEVE DISABILITY SERVICES

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