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    Personal Details

    Next of Kin, Emergency Contact Details

    Criminal History Check

    Employment Information

    Licenses & Checks


    We provide services to clients 24 hours a day, 7 days a week and will endeavour to meet your availability preferences, however cannot guarantee that all shifts offered will meet this criterion.

    Please indicate below by checking your current availability boxes*








    Skill Set

    Please indicate whether you have experience undertaking the following duties:* (please tick at least one)

    Disclosure of Pre-Existing Injuries

    Rehabilitation Care Solutions Pty Ltd is committed to providing a safe working environment for all employees. As part of this, it is our objective to ensure that employees are not required to work in duties that they are not able to perform safely.

    Under Section 82 (7&8) of the Accident Compensation Act 1985 failure to disclose information regarding pre-existing injuries or disease may result in the worker not being entitled to WorkCover compensation for that particular injury or disease in the event of recurrence, deterioration, exacerbation or aggravation of the condition.

    It is your responsibility to disclose information about any pre-existing injuries/disease, illness or medical requirements which could be affected by the nature of your proposed employment with Rehabilitation Care Solutions Pty Ltd in the. Please note: your disclosure will not prejudice the success of your application in any way.

    We advise that a failure to make a disclosure, or the making of a false or misleading disclosure, would disentitle you to compensation pursuant to the Accident Compensation Act 1985, should you suffer any recurrence, aggravation, acceleration, exacerbation or deterioration of your pre-existing injury or disease arising out of or in the course of or due to the nature of employment with Rehabilitation Care Solutions Pty Ltd.

    Rehabilitation Care Solutions Pty Ltd will rely upon any failure to disclose in accordance with the provisions of the Accident Compensation Act as grounds for denying compensation in accordance with S.82(7) and (8).


    Please provide us with the names, work telephone numbers and, if applicable, work e-mail addresses for three referees. One referee should be your current or most recent employer. You must provide details for referees that are from a managerial or supervisory background. References from friends or family members will not be accepted.

    Please note that by completing the section below you hereby authorize Rehabilitation and Care Solutions to contact work-related referees for the purpose of obtaining work-related references in its search for employment on your behalf.

    Referee One

    Referee Two

    Referee Three


    I consent to Rehabilitation and Care Solutions Pty Ltd retaining the information contained in this application form for the purposes of considering my suitability for positions that may arise. I agree to hold confidential all details given to me during the course of my work regarding clients and company policies/procedures.

    I confirm that all the above information and details I have provided in this application form and in my enclosed resume are accurate and true, and I understand that should false or deliberately misleading information be given or any material fact suppressed, I will not be accepted, or if I am employed, my employment will be terminated. Failure to supply the information requested may prejudice our ability to assess your suitability for any position.

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