Personal Particulars Form

You MUST complete this form and attach it to the front of your application. Any information that is used for statistical purposes will be treated confidentially.

Vacancy Details

Position/Reference Number / 20024056 / 17-0008
Classification / EL1 Senior Project Officer, Indicator Development
ACSQHC/
Section / Australian Commission on Safety and Quality in Health Care, Safety and Quality Improvement Systems & Intergovernmental Relations

Personal Details

Surname
First Name(s)
Postal Address / Postcode
Telephone / (Work)
(Home)
Date of Birth

Are you an Australian Citizen?Yes No 

Note: There is a general expectation that a person who is to be engaged as an APS employee will be an Australian citizen (section 22(8) of the PS Act). The Australian Government considers that it is appropriate for government employees to be Australian citizens as a demonstration of their commitment to, and long-term stake in, the future of Australia.

If no, do you have permanent residency status?YesNo 

Please indicate when you are eligible to be granted Australian Citizenship / /

Are you a member of any of the following groups?

an Aboriginal or Torres Strait IslanderYes No 

from a culturally diverse backgroundYes No 

a person with a disability?Yes No 

If you require any equipment or assistance at interview, please detail here:

......

......

If you would require an interpreter for interview, please advise which language: ………………

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CURRENT EMPLOYMENT DETAILS

Are you currently employed in the Australian Public Service (APS)?Yes No 

If yes, please complete the following:

Name of APS Department/Organisation
Address / Postcode
Classification / Actual
Nominal
AGS Number
Length of Service / Years Months

Please indicate your APS employment status: Permanent  Temporary  Fixed Term

If you are not currently employed in the APS, please complete the following:

Name of Employer
Your position in the organisation
Length of service / Years Months

May we contact you at work?YesNo

Have you been retrenched from an Australian Public Service

employer in the previous 12 months?Yes No 

Have you been retrenched from a non APSCommonwealthYes No

employer in the last 12 months? (eg. a Statutory Authority)

Please indicate here, any times/dates that you would be ______

unable to attend an interview (e.g. will be on leave etc.)

First Referee Names
Classification/Position/Title
Telephone Number
Nature and period of relationship with applicant
Second Referee Names
Classification/Position/Title
Telephone Number
Nature and period of relationship with applicant

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