Employment Application

Please complete the following details in full for consideration.

Personal Details

Please complete the following fields so that we may contact you.

First Name(s):

Surname:

Address:

Home Phone:

Mobile Number:

Email:

Do you hold a current drivers licence?

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Are you an Australian Citizen:

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If no, do you hold a temporary visa:

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If no, do you hold permanent residency:

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Position(s) of Interest

Chaffey Aged Care is a leading provider of residential aged care in Sunraysia. A number of vacancies exist across a variety of shifts for permanent, part time and casual staff.

Date Application Being Made:*

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Which position are you applying for?

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Where did you first find out about this position?

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Hours Of Work / Availablity

Please complete the following questions to indicate your availability and preferred working hours.

Please indicate your preferred employment status:

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Are you available to complete shift work?

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Do you require a minimum number of hours per week?

Please indicate how many hours you require.

Please indicate the days you are UNAVAILABLE?

Qualifications

Please list your two most appropriate education (secondary, tertiary etc), professional or trade qualifications that are relevant to the position you are applying for. Proof of these qualifications will be required at interview or offer of employment.

Qualification (One):

Issuing Institution (One):

Date Qualification Obtained (One):

Qualification (Two):

Issuing Institution (Two):

Date Qualification Obtained (Two):

Professional Registration

Please list any appropriate professional registration (Registered Nurse, Physiotherapist etc) held that are relevant to the position you are applying for. Proof of these qualifications will be required at interview or offer of employment.

Registration (Nursing/Allied Health Roles)

Expiry Date

Registration Number

Employment History

If you do not have a resume/curriculum vitae please complete your most recent employment history, or current position held.

Employer:

Position Held:

Date Started:

Date Finished:

Reason for leaving:

Referees

Please provide details of current or most recent supervisors who have agreed to be referees and who can be contacted by phone or email. If you have not worked before, personal referees will be considered.

Referees Name (One):

Company (One):

Position (One):

Contact Details (One):

Was this referee your direct supervisor (One)?

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Referees Name (Two):

Company (Two):

Position (Two):

Contact Details (Two)

Was this referee your direct supervisor (Two)?

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Criminal History Check

All applicants for positions with Chaffey Aged Care are required under the Aged Care Act 1997 (the Act) to undergo a national criminal history record check. In addition, all applicants must provide a statutory declaration certifying that since the age of 16 years they have not been: a) convicted of murder or sexual assault, or b) convicted of, and sentenced to imprisonment for, any other form of assault.

Criminal history checks are mandatory in aged care

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Occupational Health & Safety

To assist Chaffey Aged Care to comply with their obligation to ensure a safe workplace and in order to determine whether applicants are able to safely and adequately perform the requirements of a position.

To the best of your knowledge:

do you have any condition/s that would prevent you from undertaking the duties of the the position you have applied for?

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Comments:

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Declaration

I understand that any false or misleading information given in this application, whether in writing or during an interview, may be reason for my employment, if I am appointed, to be terminated.

I declare that:

to the best of my knowledge and information provided in or in relation to this application, is true, complete and correct.

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File Attachments

Please attach one PDF document combing your resume and statement addressing the key selection criteria for the relevant position description.

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Permission to retain application for 12 months?

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Send me a copy of my responses

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