This document will become Sensitive:Personal (after first entry)

For applications not submitted through the department’s online recruitment system - you should complete this form and attach it to the front of your application.

DETAILS OF ADVERTISED VACANCY
PositionTitle:
Job Position Number:
Division: / Branch:
Section:
Source of Advertisement: / Advertisement Date:

PERSONAL DETAILS

Surname: / Given Name(s):
Postal Address:
Work Phone: / Home Phone: / Mobile Phone:
Email Address:
SECURITY
Do you hold a current security clearance? / Yes
No
If Yes, please specify the level:
Are your willing to undergo a police check? / Yes
No
Please note: You must be willing to undergo a police check to be eligible for a position with Department of the Environment and Energy.
AUSTRALIAN CITIZENSHIP DETAILS
Place of Birth: / Date of Birth:
Australian Citizenship: / Yes
No
Note: Potential employees must hold Australian Citizenship. Permanent Residency status does not meet this requirement. Please contact the Recruitment Team if you have any queries regarding this matter.
EMPLOYMENT DETAILS
If you are currently or have been employed in the Australian Public Service, a Statutory Authority or in the ACT Government, please complete the following details:
Department/Agency Name:
AGS Number:
Have you worked for this department before? / Yes or No / Please specify Dates: / From: To:
If you have not been employed in the Australian Public Service, a Statutory Authority or in the ACT Government, please complete the following details:
Current Employer:
Note: Referees may be contacted at any stage of the recruitment process
WORKPLACE EQUITY AND DIVERSITY DETAILS(optional)
A requirement of Australian Public Service (APS) agencies under the Public Service Act 1999 is to promote equity and diversity in employment. This means that members of the Australian community have an equal opportunity to compete for jobs in the APS regardless of their gender, race, ethnicity or physical or mental disability. Critical to the success of the Department’s equity and diversity strategies and policies is the collection and analysis of equity and diversity data. Your responses will be treated with the strictest of confidence. Please note that at each stage of the questionnaire, you have the option of choosing not to give this information. To assist you the Australian Bureau of Statistics definition of disability is available on the second last page of this form.
Do you wish to identify yourself as a member of any of the following groups:
Aboriginal and/or Torres Strait Islander: / Non-Indigenous Indigenous Prefer not to disclose
Principal Disability[1]: / Disability No Disability Prefer not to disclose
First language spoken: / English Only English and another language
Language other than English Prefer not to disclose
If other than English Only, Please specify:
Mothers First Language: / English Only English and another language
Language other than English Language unknown
Prefer not to disclose
Fathers First Language: / English Only English and another language
Language other than English Language unknown
Prefer not to disclose
Where you born outside of Australia: / Yes No
If yes please specify, Country of birth:
Date of arrival in Australia:
Person who requires special arrangements to be made for their interview. If yes a member of the Selection Advisory Committee will contact you for more details: / YES NO
DISABILITY SUPPORT (optional)
The Department has a range of supports available for people with disability, including an employees network, reasonable adjustments and a disability coordinator. Would you like to be contacted in relation to this support? / YES NO
VOLUNTARY REDUNDANCY PACKAGE:
If you have accepted a voluntary redundancy from an APS Agency or the Australian Parliamentary Service, have you completed your restriction period? / Yes No
If Yes, date due to finish:
APS CODE OF CONDUCT
Have you ever been determined to or found to have breached the APS Code of Conduct in connection with any previous employment? If yes, please provide details (attach an extra page with details) / Yes No
DISCLAIMER
The information you provide on this form must be true and correct. If it is consequently discovered that the information you have provided is false and/or misleading, you be assessed as unsuitable for employment with the department. Further, providing false and/or misleading information may be considered a potential breach of the APS Code of conduct as well as a potential contravention of the Criminal Code Act 1995.
PRIVACY STATEMENT
The Department is collecting personal information in the course of your engagement and in the course of your employment to manage your employment with the Department. This information may be used or disclosed in order to assess your suitability for employment with the Department or for other employment-related purposes. It will be treated in accordance with the provisions of the Privacy Act 1988. Some or all of this information may be passed on to other relevant areas within the Department or to other Commonwealth agencies including the Australian Public Service Commissioner, the Merit Protection Commission and the Australian Government Security and Vetting Agency (if a security clearance process is required). The Department usually gives some or all of this information to: The Department of Finance and The Australian Taxation Office.
If a different Commonwealth agency employs you in the future, this Department usually gives information from these forms to the new employer.
DECLARATION
I confirm the information I have providedon this application formis true and correct. I acknowledge if it is subsequently discovered that the information I have provided is false and/or misleading, that I may be assessed as unsuitable for employment with the Department. I further acknowledge providing false and/or misleading information may be considered a potential breach of the APS Code of Conduct.

Please ensure your resume and application are attached to this form, once complete please email the Departments Recruitment Helpdesk . If you require further assistance please contact the Recruitment Team on 6274 1121.

Definition in the Australian Bureau of Statistics - 2003 Disability, Ageing and Carers Survey

A person has a disability if they report that they have a limitation, restriction or impairment, which has lasted or is likely to last, for at least six months and restricts everyday activities. This includes:

  • Loss of sight (not corrected by glasses or contact lenses)
  • Loss of hearing where communication is restricted, or an aid to assist with , or substitute for, hearing is used
  • Speech difficulties
  • Shortness of breath or breathing difficulties causing restriction
  • Chronic or recurrent pain or discomfort causing restriction
  • Blackouts, fits or loss of consciousness
  • Difficulty learning or understanding
  • Incomplete use of arms or fingers
  • Difficulty gripping or holding things
  • Incomplete use of feet or legs
  • Nervous or emotional condition causing restriction
  • Restriction in physical activities or in doing physical work
  • Disfigurement or deformity
  • Mental illness or condition requiring help or supervision
  • Long-term effects of head injury, stroke or other brain damage causing restriction
  • Receiving treatment or medication for any other long-term conditions or ailments and still restricted
  • Any other long-term conditions resulting in a restriction in everyday activities.

Applicant Details FromOctober 2017Page 1 of 3