CONFIDENTIAL
APPLICATION FOR THE POSITION OF
………………………………………..
NAME ......
ADDRESS ......
......
......
POST CODE ......
E-Mail ......
TELEPHONE ......
(CV’s will not be accepted without an accompanying completed application form)
Email to: /
Fax to: / (02) 9727 4943
Post: / Human Resources,
Community First Step,
PO Box 52
Fairfield NSW 1860
GENERAL INFORMATION
Do you have a work permit to work in the Australia? / YES NO
Do you hold a current NSW driving licence? / YES NO
Where did you obtain information about this vacancy?
Have you previously applied for any post with Community First Step?
If yes, which post and when? / YES NO
Medical Details
Do you have a medical condition that may prevent you from fulfilling any of the duties that may reasonably be expected of you?
(If yes, please give details on a separate sheet) / YES NO
Do you have any disabilities that may affect your application? / YES NO
If yes, please describe disabilities on a separate sheet and include;
(a)any reasonable adjustments which you feel should be made to the recruitment process to assist in your application for the job
(b)any reasonable adjustments which you feel should be made to the job itself which would enable you to carry out the role.
Convictions
Child Protection
Have you any past convictions, cautions, bind-overs or pending cases affecting your suitability to work with young people?
If you have replied YES, you are required to give details on a separate sheet.
Please note:
All applicants will be required to provide evidence of their Working With Children check before an appointment can be fully confirmed. / YES
NO 
Do you have any workers compensation claims pending at the moment?
YES NO 
Details:
Referees
Please provide the names and contact details of three referees. These should not include relatives or personal friends. Ideally, you should provide the name of your current direct Line Manager in your present or most recent employment as one of your referees or if you are a college or university leaver your Departmental Head or Tutor.
Please tick the box if you do not wish us to take up references from your current employer before interview 
1.
2.
3. / Relationship
Relationship
Relationship
EMPLOYMENT HISTORY
Currentrole: (Ifunemployed, please give details of your last job)
Employers Name & Address:
Nature of Business:
Your Position:
Date joined:
EMPLOYMENT HISTORY (continued)
NOTICE REQUIRED BY PRESENT EMPLOYER?
Previous Jobs (Since completing full time education - enter the most recent first)
Dates
From/To / Name of Employer and Nature of Business / Position Held / Duties &
Responsibilities / Reason for leaving
EDUCATION AND QUALIFICATIONS
Qualifications will only be taken into account where they are strictly required for the post.
Community First Step we will require evidence of these qualifications.
School, College, University, etc. / Dates / Qualifications gained including subjects, grades or results expected Attainments
PROFESSIONAL QUALIFICATIONS
(Give details of any other relevant qualifications or records of achievement (e.g. courses attended), certificates attained, including membership and status of any relevant Professional or Technical Association certificate number, date of issue & issuing authority)
COURSES ATTENDED/SKILLS ACQUIRED/FOREIGN LANGUAGES SPOKEN
(Please summarise any other skills that you have and/or training that you have received that may be relevant to the position you are applying for)
HOW DO YOU FEEL YOU FULFILL THE ESSENTIAL AND DESIRED CRITERIA FOR THIS ROLE?
WHAT DO YOU THINK SEPARATES YOU FROM OTHER APPLICANTS THAT WE MAY HAVE FOR THIS ROLE?
IS THERE ANY OTHER INFORMATION THAT WOULD SUPPORT YOUR APPLICATION?

Strictly Confidential

(Not to be used in selection process – place in sealed envelope if you like)

Equal Employment Opportunity (EEO) Data Collection

Completion of this form is voluntary. We ask for your co-operation.

Name ______

Q1. Are you female or male?

 Female

 Male

Q2. Are you an Aboriginal or Torres Strait Islander?

An Aboriginal or Torres Strait Islander is a person of Aboriginal or Torres Strait Island descent, who identifies as such and is accepted as such by the community in which he or she lives.

If you are both Aboriginal and Torres Strait Islander, please mark both "Yes" boxes.

 Yes, Aboriginal...... Please go to Question 5

Yes, Torres Strait Islander...... Please go to Question 5

 No

Q3. Are you from a racial, ethnic or ethno-religious group which is a minority in Australian society?

You should answer "yes" to this question if you are from a minority because of any of the following:

  • your language background or accent
  • your religion or culture
  • your ethnic or racial appearance
  • your country of birth or descent

 Yes

 No

Q4. What language did you first speak as a child?

 English

Other Language

Q5. Are you a person with a disability?

You should answer "yes" to this question if you have any one or more of the limitations or restrictions listed below:

• a long term medical condition or ailment

• speech difficulties in your native language

• disfigurement or deformity

• a psychiatric condition

• head injury, stroke or any other brain damage

• loss of sight or hearing

• incomplete use of any part of your body

• blackouts, fits or loss of consciousness

• restriction in physical activities or in physical work

• slowness at learning or understanding

• any other condition resulting in a restriction

 Yes

 No

If "no", you do not need to answer any more questions. Thank you.

If yes, do you require adjustment to be made at work?

You should answer "yes" to this question if your disability would make it necessary to change any of the following:

• the tasks of the job

• the workplace or work area

• how others behave towards you at work

• the equipment you use

• your working hours

 Yes

 No

THANK YOU FOR COMPLETING THIS FORM

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