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Employment Application Form: Position Applied For: Permanent: Casual: Personal Details

This document is an employment application form for Somerville Community Services Inc. that must be fully completed with accurate personal and employment details. Applicants are asked to provide references, disclose any criminal history, and authorize a medical examination if requested. Completing the form does not guarantee employment and any information provided will only be used for employment purposes.

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Karen Karento
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299 views2 pages

Employment Application Form: Position Applied For: Permanent: Casual: Personal Details

This document is an employment application form for Somerville Community Services Inc. that must be fully completed with accurate personal and employment details. Applicants are asked to provide references, disclose any criminal history, and authorize a medical examination if requested. Completing the form does not guarantee employment and any information provided will only be used for employment purposes.

Uploaded by

Karen Karento
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Original Date: 1996 A3

Reviewed: July 2014

EMPLOYMENT APPLICATION FORM


 This is a standard application form for employment with Somerville Community Services Inc.
 This application form must be completed fully and as accurately as possible.
 It is essential for the processing of your application for employment that all questions are answered.
 No guarantee of employment is given by the completion of this form.
 The information on this form will be used for employment purposes only.
 Somerville will not use nor disclose this information for any other purpose without your written consent.

POSITION APPLIED FOR: Permanent: Casual:

PERSONAL DETAILS:
Title: Please tick one Mr Mrs Ms Miss Other, pls specify:
Surname: First Name:
Home Address: State: Postcode:
Postal Address: State: Postcode:
Date of Birth: (optional) Tel - Tel - Business:
Home:
Mobile: Email:
Driver’s Licence: Class: State:
Are you legally entitled to work in Australia? No: Yes:
If yes, do you have any restrictions? No: Yes: Pls specify:
Please provide evidence of entitlement to work in Australia eg Australian Passport, Australian Citizenship Certificate, a valid
visa checked through Vevo, Birth Certificate.

EDUCATION/QUALIFICATIONS:
Level Completed Details Education/Training Provider Year
Year 9, 10, 11, 12
Certificate
Diploma
Degree
Trade
First Aid
Other

EMPLOYMENT HISTORY:
Employment
Dates Employer Position/s Held Reason for Leaving

HEALTH HISTORY:

Some positions may entail repetitive actions and/or physical work involving manual handling/lifting.
Do you have or have you had a disability, injury, impairment or illness which may affect
your ability to carry out the duties of the position applied for? No Yes
If yes, please provide details:
Are you currently taking or have you previously taken medication which may affect your
ability to carry out the duties of the position applied for? No Yes
If yes, please provide details:
Have you sustained an injury whilst previously employed? No Yes
If yes, please provide details:
Would you agree to undergo a medical examination if requested? No Yes
CRIMINAL HISTORY/WORKING
WITH CHILDREN CLEARANCE:
A criminal record will not necessarily preclude you from employment, but full disclosure is required. A current
(within the last three months) Criminal History Check is a requirement for all positions.
Have you ever been arrested, prosecuted or charged in respect of any criminal offence?
No Yes
If yes, please provide details:
Have you any reason to believe that any prosecution or charge against you may be
pending? No Yes
If yes, please provide details:
Do you have a current Working With Children Clearance, if yes, please attach a copy
No Yes

REFEREES:

Please provide details of at least 2 work related referees from whom we may obtain further information about
your application. Please note referee checks may be conducted at any point during the application process.
Name Company Relationship Phone No.

OTHER INFORMATION:

Have you previously applied for a position or worked at Somerville? No Yes


If yes, please provide details:
Give details of any interests, activities or special skills which may support your application.

In which publication or medium did you see the job(s) advertised?


Memo Notice Board Newspaper
Website Family/Friends Other Organisations
Others, please specify.

DISABILITY SERVICES APPLICANTS ONLY:


Preferred Location/s: Darwin Howard Springs Katherine
Employment Type: Please refer to the Roster for more details.
Full Time Part Time Night Shift Casual, specify availability below
Mon Tue Wed Thu Fri Sat Sun
Early
Late
Night

DECLARATION BY APPLICANT:

I declare

 That the answers to this application are, to the best of my knowledge, true and correct in every way.

 That if my application for employment is successful I will be bound by, and will at all times observe and
respect, such terms and conditions of my employment and such policies and rules as may from time to time
be implemented, specified or otherwise stipulated by my employer.

 That I understand that any misleading or false declarations made by me in this application may result in
disciplinary action or possible dismissal.

Applicant’s Signature: Date:

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