This Form MUST Be Attached to Each Application for Employment Lodged
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APPLICANT INFORMATION SUMMARY This form MUST be attached to each application for employment lodged
NAME OF POSITION YOU ARE APPLYING FOR: ......
NAME: ………………………………………………….. ……………………………………………….. Surname Given Names ADDRESS: ...... TELEPHONE: (Home) ...... (Mobile) ...... P/CODE: EMAIL: ...... ……………………………………………… DO YOU CURRENTLY HOLD A DRIVERS LICENCE? YES
DRIVER’S LICENCE NO: …………………………………. LICENCE EXPIRY DATE: …………………….
Do you hold or are you eligible to apply for a Suitability Card (Blue Card) from the Commission for Children Young People and Child Guardian?
YES If yes is your card current? YES
Copy of “Blue Card” attached? YES
There are some positions in TAIHS that are “identified” positions these can only be filled by Aboriginal or Torres Strait Islander applicants – please complete this section to allow consideration for the most appropriate employment options.
Do you identify as a member of the Aboriginal and/or Torres Strait Islander community? YES NO Are you of Australian South Sea Islander descent? YES NO Are you a person from a non-English speaking background? YES NO
QUALIFICATIONS
PLEASE TICK YOUR HIGHEST ACADEMIC QUALIFICATION COMPLETED:
GRADE GRADE GRADE TERTIARY QUALIFICATION 1-10 11 12
PLEASE LIST TERTIARY QUALIFICATIONS (completed)
______
PLEASE LIST CURRENT TERTIARY STUDIES ______
______
PLEASE LIST SIGNIFICANT TRAINING (completed) ______
______
Doc_0543 Applicant Information Summary Reviewed: May 2016 Page 1 of 3 REFEREE INFORMATION
Please provide contact information of at least two (2) (employment related) referees who may be contacted for a written or verbal reference
NAME & ADDRESS: ………………………………………………………………………………………………......
......
OCCUPATION and/or RELATIONSHIP...... …………………………..
TELEPHONE: (WK) A/H: PERIOD KNOWN:
NAME & ADDRESS: ......
OCCUPATION and/or RELATIONSHIP....COMMUNITY ELDER / MENTOR......
TELEPHONE: (WK) A/H: PERIOD KNOWN:
NAME & ADDRESS: ......
......
OCCUPATION and/or RELATIONSHIP......
TELEPHONE: (WK) A/H: PERIOD KNOWN: ......
ELIGABILTY TO WORK
Are you an Australian or New Zealand citizen? YES NO If “NO” (Please attach a copy of documentation confirming eligibility to work within Australia)
HEALTH AND SAFETY
Have you any physical, mental, health or emotional condition that should be known to TAIHS in case such condition may affect your health and safety in particular work situations? YES NO If YES, Give Details...... ……………………...... ………………...
...... ………………...
What is your current employment status? (please circle)
Unemployed School Tertiary Studying Employed (Casual) (Part-time) (Fulltime)
I declare that my answer is honest and complete
APPLICANT’S SIGNATURE: ...... DATE: / /
Please send this form and your application to:
TAIHS Human Resources – [email protected]
Doc_0543If you Applicant do not Information provide Summaryall required documentation Reviewed: you may May 2016not be considered for shortlisting. Page 2 of 3 Doc_0543 Applicant Information Summary Reviewed: May 2016 Page 3 of 3