BlueWave Living

APPLICATION FOR EMPLOYMENT

5-6 Kathleen Street Woy Woy NSW 2256

PO Box 21 Woy Woy NSW 2256

email: Phone: 4344 2599 Fax: 4344 6306

Position applied for ……………………………………………

Preferred Title: / Mr/Mrs/Ms/Miss / Date of Birth (optional)
Surname: / Given Names:
Address:
Telephone / Private: / Business: / Mobile:
Email:
Current Practising Certificate No: (if applicable)

Please provide your work experience details in chronological order, commencing with your most recently held position.

Employer / Position Held / From / To / Reason for leaving
1.
2.
3.
4.

Please provide details of your educational qualifications:

Qualification Attained / Institution / Year
1.
2.
3.
4.
5.

Contact details for 3 referees, at least 2 should apply to previous employment:

Name / Address / Designation / Contact Telephone

Are you willing to undertake a medical examination & functional Assessment Yes / No

Are you immunised against Hep B? Yes / No

Are you willing for us to contact your previous employer as a referee? Yes / No

Are you legally entitled to work in Australia? Yes / No

Are you willing to work weekends? Yes / No

Are you willing to work shifts? Yes / No

Are you over 18 years of age? Yes / No

Please tick the shifts and days you would be available to work;

Day / Morning shift / Afternoon shift / Night shift
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday

Do you have a physical restriction which would prevent you from carrying out the functions of the role you have applied for? Yes / No If yes please give details:

______

______

POLICE RECORD CHECKS

All staff working in aged care are required to have a current Aged Care Employee – Part Exclusion, Police Certificate. It is the responsibility of any new staff member recruited to provide a current Aged Care Employee – Part Exclusion, Police Certificate. An application is available at reception on request.

Are you the subject of any criminal charge(s) still pending before a court, or have you been the subject of criminal conviction(s) or finding(s) of guilt before a Court which are not “pardoned, quashed or spent convictions under Legislation

Yes  No  If YES provide details: ______

Refusal to obtain a police certificate and/or provide a statutory declaration where applicable will preclude a person from employment with the company. An assessment of a police certificate, and any recorded convictions will be undertaken to assess the suitability to work in this organization.

ELIGIBILITY TO WORK IN AUSTRALIA

Copies of the following documentation must be provided:

Documents

Australian citizenship may be proven in the following ways:

• Full Australian birth certificate (if born before 20 August 1986) and a form of photo ID

• Full Australian birth certificate (if born on or after 20 August 1986), a form of photo ID and evidence that at least one parent was an Australian citizen or permanent resident at the time of the child's birth

• Australian citizenship certificate and a form of photo ID, and

• Australian passport issued on or after 22 November 1984.

The visa status of a non-citizen may be established in the following ways:

• Permanent resident status shown by visa label showing "nil conditions", plus photo ID

• Permanent resident status shown by certificate of residence, plus photo ID

• Proof of New Zealand citizenship with a valid passport, or

• Foreign national passport and temporary visa holder shown by visa label with work conditions specified, plus photo ID.

I understand and agree:

1.  That all statements in this application are correct to my knowledge.

2.  That it will be my responsibility to obtain evidence of all my previous service to gain recognition for award purposes.

3.  That the terms and conditions of my employment will be in accordance with the appropriate industrial award or agreement and the Policies and Procedures of BlueWave Living.

Signed: Date:

Form/Human Resource/Employment Forms/ Employment Application Form No. 107 Page 1 of 2

Implemented 13.06.01 Revised 26.11.14