Test Page

Attachments

Attach cover letter*

Attach resume*

Personal Details

Surname*

Given Name(s)*

Address*

Suburb*

Postcode*

Phone (H)

Mobile

Date of Birth

Gender*
MaleFemale

Email Address*

Languages Spoken*

Country of Birth*

Are you of Aboriginal or Torres Islander origin?*
AboriginalTorres Strait IslanderNoN/A

Are you an Australian or New Zealand resident?*
AustralianNew ZealandNo

If no, do you have a visa entitling you to work?
YesNoN/A

If yes, what type of visa? (if applicable)

Do you have a driver’s license?*
YesNo

License Type (if applicable)
FullP PlateN/A

State/Country Issued (if applicable)

Do you have roadworthy and registered vehicle?*
YesNo

Does your vehicle have child locks? (if applicable)
YesNoN/A

Does your vehicle have adequate space to store a foldable wheelchair? (if applicable)
YesNoN/A

What level of insurance do you have on your vehicle? (if applicable)
ComprehensiveThird partyNoneN/A

Next of Kin, Emergency Contact Details

Surname*

Given Name(s)*

Address*

Suburb*

Postcode*

Phone (H)

Mobile

Criminal History Check

Have you ever been found guilty of a criminal offence?*
YesNo

If yes, please describe:

Are you awaiting the hearing of charges, or have ever been convicted of a criminal offence in a civil or law?*
YesNo

If yes, please describe:

Employment Information

Licenses & Checks

Police Check (less than 12mths) Date Issued:*

Working with Children’s Check Date Issued:*

First Aid Certificate Date Issued:*

CPR Date Issued:*

Qualifications*
Disability Cert IIIDisability Cert IVAged Care Cert IIIAged Care Cert IV

Other Qualifications/ Current Study

How many hours per week are you interested in working?*

Work locations preferred*

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.

I declare that I have a pre-existing injury or illness:*
YesNo

If yes, please describe in the space below:

Have you ever made a WorkCover claim before?*
YesNo

If yes, please describe in the space below:

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).

Referees

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

Name*

Position*

Organisation*

Contact telephone number*

Email Address*

Referee Two

Name*

Position*

Organisation*

Contact telephone number*

Email Address*

Referee Three

Name*

Position*

Organisation*

Contact telephone number*

Email Address*

Are you registered with a Centrelink Job Services Australia agency/provider?*
YesNo

If so, please indicate agency/provider and consultant details?

If Friends (who?)

If Other (detail)

Declaration

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.

I consent to these conditions.

Monday	AMPMSleepoverActive Night
Tuesday	AMPMSleepoverActive Night
Wednesday	AMPMSleepoverActive Night
Thursday	AMPMSleepoverActive Night
Friday	AMPMSleepoverActive Night
Saturday	AMPMSleepoverActive Night
Sunday	AMPMSleepoverActive Night

Attachments

Personal Details

Next of Kin, Emergency Contact Details

Criminal History Check

Employment Information

Availability

Skill Set

Disclosure of Pre-Existing Injuries

Referees

Declaration