Public sector university cadetships for people with disability
Expression of interest form

Please complete all the sections

Section 1
Nominee details
Title / Mr / Ms / Mrs / Dr (please circle)
First name / Given name
Surname
Gender / Male Female Other
Date of birth / Date / Month / Year
Mailing address
University email
Preferred email contact
Contact phone number
Section 2
Residency details
Are you an Australian citizen or permanent resident of Australia? / Yes No
If no, do you have a visa that allows you to live and work in Australia?
If yes, provide details. / Yes No
Visa expiry date:
/ Passport number:
Issuing country:
Please include any visa information as an attachment to this application.
Section 3
Diversity information
(The following information is requested for statistical and eligibility purposes only)
Do you identify as Aboriginal or Torres Strait Islander? / Aboriginal - Yes No
Torres Strait Islander - Yes No
Both Torres Strait Islander and Aboriginal - Yes No

This information will assist the Commission to improve learning and development outcomes for ATSI employees.
Do you have a disability / Yes No
If yes, please provide details of your disability / Yes No I choose not to provide this information
Completion of this field is optional. However, disclosure may assist us to better support you in a job role. All personal information will be kept confidential in compliance with the Privacy Act 1988. If you require more information about your decision to disclose, please refer to the information in Supporting the decision about whether or not to disclose on the JobAccess website.
Do you, to the best of your knowledge, have a medical condition that may preclude you from undertaking the duties of this position? / Yes No
If “Yes”, please provide details:
Do you have any special requirements, e.g. accessibility, modifications to work tools or flexible work arrangements? / Yes No
Please provide further information:
Are you registered with a Disability Employment Service provider? / Yes No
If yes, please proceed to next question. If no, please go to Section 4.
Section 3
Diversity information
(The following information is requested for statistical and eligibility purposes only)
Disability Employment Service provider details / Name:
Case manager:
Telephone :
Email:
Section 4
Current employment details
Are you currently employed in the West Australian public sector? / Yes No
If yes, are you permanent or on contract? / Permanent Contract
Have you ever received a voluntary severance payment from the West Australian public sector? / Yes No
If yes, what is your re-entry date on your Deed of Severance:
Substantive position:
(do not list acting positions) / Department
Position Title:
Award & Classification:
Section 5
Study details
Which university are you currently enrolled in?
Outline your course of study and any major and/or minor areas of study
Will you be entering your final year of your studies in 2017? / Yes No
Is this an honours year? / Yes No
Section 6
Referees
University referee / Surname: / Given name/s:
Position title:
Phone: / Mobile:
Email:
Other referee / Surname: / Given name/s:
Position title:
Phone: / Mobile:
Email:
Section 7
Criminal convictions
Do you have any current criminal convictions for any offences from any court, or are you currently the subject of any charge pending before any court? / Yes No
Details:
You do not need to give details for any conviction which you have had declared spent (West Australian Spent Convictions Act 1988). If rejection of your application is considered solely because of a criminal record, you will be given the opportunity to discuss the matter fully before a final decision is made.
Section 8
Checklist
Expression of interest form is complete and attached / Yes No
One page statement addressing the three questions / Yes No
Copy of most recent academic transcript is attached / Yes No
Copy of current university enrolment is attached / Yes No
Current curriculum vitae is attached / Yes No
Copy of current working visa is attached (if appropriate) / Yes No
Declaration
I declare the above statements to be true in all respects
Signature:
/ Date:
Submitting your application
Email (preferred) /
Post / University Cadetships
Public Sector Renewal
Public Sector Commission
Locked Bag 3002
WEST PERTH WA 6872
Enquiries / Telephone: (08) 6552 8500
Fax: (08) 6552 8710
Email:
Website: www.publicsector.wa.gov.au

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