DISABILITY SUPPORT WORKER APPLICATION FORM

PERSONAL DETAILS

TITLE:______SURNAME:______GIVEN NAMES:______

DATE OF BIRTH:______CITY & COUNTRY OF BIRTH:______

ADDRESS:______

SUBURB:______STATE:______POST CODE:______

PHONE NUMBER:______MOBILE NUMBER:______

EMAIL ADDRESS: ______

ARE YOU AN AUSTRALIAN RESIDENT? YES NO

IF NO, PLEASE PROVIDE VISA DETAILS ______

APPLICATION DETAILS

  1. Why do you want to work with children with a disability?

______

  1. What are some of your special interests, passions and hobbies that you could share with children with a disability? Eg sport, music, dance, gardening etc

______

  1. Give us some examples of your own involvement in your local community? e.g.clubs, activities, studies, part time work, church groups, etc.

______

  1. What skills/qualifications/experience do you have that will help you to work with children with disabilities? Please provide details

______

  1. Are you willing to attend initial orientation and ongoing training and supervision meetings to assist in your role as a support worker with St Anthony’s Family Care?

______

  1. Do you currently work with any other organisations?If so please provide details.

______

  1. Do you have a current first aid certificate? If not, are you prepared to obtain one

______

  1. Do you have a current Working with Children Check? If not, are you prepared to obtain one

______

AVAILABILITY AND WORK PREFERENCES

  1. When would you be available to work?

□ Weekly / □ Fortnightly / □ Monthly
Day/ Times / Mon / Tues / Wed / Thurs / Fri / Sat / Sun
School Holidays
  1. What is your preferred way of working?

Regular shift with same child/children

Happy to be on call for last minute/one off shifts with a range of different children

Group work only

No group work

School holidays only

Weekends only

Evenings only

Other preferences

______

  1. Do you have any preference for the age range of the children you would like to work with?

6-12

12 – 15

15-18

Any age is ok

  1. Do you have experience working with people from different cultural backgrounds? Please provide details.

______

  1. Do you speak any languages other than English? Please provide details

______

I hereby declare that I am the applicant named in this form. All information in this form is true and correct. I understand that if I have provided false or misleading information it may result in a decision not to employ me, or, if already employed, may lead to my dismissal

Applicant’s Signature: ______Date:______

Please attach a copy of your current resume if available and forward to:

Helen Danes, Business Services Co-ordinator

9 Alexandra Ave Croydon NSW 2132

or by email to: