Application for Employment

Position Details

Position Applied For:

Type of Work:

Full TimePart TimeCasual

When will you be available to start work: *

Personal Details

Do you identify as Aboriginal/Torres Strait Islander? *

YesNo

Other Title: *

First Name: *

Surname: *

Preferred Name:

Date of Birth: *

Right to work in Australia - Citizens must provide evidence of citizenship in the form of birth certificate, citizenship certificate or passport. Non-citizens must provide a copy of their passport or ImmiCard.

Are you an Australian citizen? *

YesNo

Please provide a copy of your Birth Certificate, Citizen Certificate or Passport: *

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Please provide a copy of your ImmiCard: *

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Arrival Date: *

ImmiCard No: *

Home Address: *

Suburb: *

State: *

Postcode: *

Mobile: *

Email Address: *

100 Points of Identification

The NDIS have outlined a standard points system for identification for all NDIS support workers.
The standard system for ID is as follows:

100 Points of identification consists of a combination of at least one primary identification document and one secondary identification document. Secondary documents must include your full name, and your photograph or signature.

Primary identification documents (70 points each) include:

Current AHRPA Registration:

Please upload a copy of your AHRPA regisitration: *

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Birth Certificate:

Please upload a copy of your birth certificate: *

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Citizenship Certificate:

Please upload a copy of your citizenship certificate: *

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Passport (Current Passport or Password that was not cancelled and was current within the preceding two years):

Please upload a copy of your passport: *

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Secondary identification documents (40 points each) include:

Australian Drivers Licence: (please note this must be a current Australian Drivers licence)

Please upload a copy of your Drivers Licence: *

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Identification card for an Australian Public Employee:

Please upload a copy of your Public Employee Identification Card: *

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Identification card issued by the Commonwealth, a State or Territory as evidence of entitlement to a financial benefit:

Please upload a copy of your Commonwealth ID Card: *

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State or Teritory issued personal Identification card:

Please upload a copy of your State or Territory Personal ID Card: *

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Student card issued by an Australian tertiary education institution:

Please upload a copy of your Student ID Card: *

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Employment History

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

Position #1

Are you currently employed in this Position? *

YesNo

Start Date of Employment: *

Finish Date of Employment:

Company Name: *

Position Held by Applicant: *

Position #2

Start Date of Employment:

Finish Date of Employment:

Company Name:

Position Held by Applicant:

Position #3

Start Date of Employment:

Finish Date of Employment:

Company Name:

Position Held by Applicant:

Do you need to give notice to current employer? *

YesNo

How Long? *

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

YesNo

Holidays - Give details: *

References

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

Referee #1

Referee 1 - Company:

Person to contact:

Business Phone No:

Position Title:

Referee #2

Referee 2 - Company:

Person to contact:

Business Phone No:

Position Title:

Occupational Licences, Certificates and Industry Requirements

Each of the following are a requirement of employment with Reliability Support and Care Services.

Please indicate your licences/training (please provide copy/s with your application)

First Aid: (Required) *

Please upload First Aid Certificate: (Required) *

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Perform CPR: (Required) *

Please upload Perform CPR Certificate: (Required) *

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Worker Screening Check: (Required) *

Please upload your Worker Screening Card or Yellow Card: (Required) *

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Blue Card: (Required - Note: If applying for a new Blue Card and Worker screening card, both can be obtained through the worker screening portal link at a lower cost) *

Please upload your Blue Card: (Required) *

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Police Check (If worker screening card is supplied the police check will be carried out as part of this process):

Please upload your Police Check documentation: (Not Required if Worker Screening Card is provided) *

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NDIS Worker Orientation Module: Quality, Safety and You (Required) *

Please upload your NDIS Worker Orientation Module Certificate: (Required) *

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NDIS New Worker Induction Module: (Required for Workers New to the Industry)

Please upload your NDIS New Worker Induction Module Certificate: (Required for Workers New to the Industry) *

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Covid-19 Vaccination Status Digital Certificate: (Required- available through the medicare link in your mygov account) *

Please upload your Covid-19 Vaccination Certificate *

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Education and Qualifications

** Please detail your qualifications and provide certificates where possible**

Have you completed a certificate 3 in Disability or other relevant aged care or disability certification?

Please upload your Certificate 3 or other in Disabilities/Aged care certificate: *

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Other Certificate Level Qualification:

Diploma Level Qualifications:

Trade Qualifications:

Degree Level Qualifications:

Health and Safety / Medical Questions

** Please answer the following questions and provide details where applicable**

Do you have any injuries, impairments that impact on your ability to perform work?

YesNo

If yes please outline Condition details:

Are you currently taking any medication?

YesNo

Medication Details:

Are you allergic to anything including medications?

YesNo

Allergy Details:

Do you have any current restrictions lifting?

YesNo

Restriction Details:

Do you suffer from frequent migraine headaches?

YesNo

Migraine Details:

Seizures, Epilepsy?

YesNo

Condition Details:

Diabetes?

YesNo

Condition Details:

Drugs and Alcohol in the Workplace - Zero Tolerance Policy

We have a zero tolerance policy for the consumption and presence of drugs and alcohol whilst at work.

Drug and Alcohol testing will occur and is on a random basis

Do you have any concerns undergoing Drug and Alcohol testing?

YesNo

Privacy & Personal Information Consent

Please complete the following consent statement

I, *

consent to the collection of necessary personal information, including age, gender, medical history / reports, address details, and the disclosure of information to third parties, medical practitioners and psychological service providers.

I agree to undertake all medical tests and examinations as required to ensure my capability to perform the tasks required of the position for which I have applied.

I hereby declare that the information I have provided in this form is true and accurate and I authorise the company to verify any information if required. Any false or misleading information may result in the termination of my position / application.

I have read and understood my rights in respect of access to and collection of my personal information.

Signed

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