<p> APPLICANT INFORMATION SUMMARY This form MUST be attached to each application for employment lodged</p><p>NAME OF POSITION YOU ARE APPLYING FOR: ...... </p><p>NAME: ………………………………………………….. ……………………………………………….. Surname Given Names ADDRESS: ...... TELEPHONE: (Home) ...... (Mobile) ...... P/CODE: EMAIL: ...... ……………………………………………… DO YOU CURRENTLY HOLD A DRIVERS LICENCE? YES  </p><p>DRIVER’S LICENCE NO: …………………………………. LICENCE EXPIRY DATE: …………………….</p><p>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?</p><p>YES  If yes is your card current? YES  </p><p>Copy of “Blue Card” attached? YES  </p><p>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. </p><p>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</p><p>QUALIFICATIONS</p><p>PLEASE TICK YOUR HIGHEST ACADEMIC QUALIFICATION COMPLETED:</p><p>GRADE GRADE GRADE TERTIARY QUALIFICATION 1-10 11 12 </p><p>PLEASE LIST TERTIARY QUALIFICATIONS (completed)</p><p>______</p><p>PLEASE LIST CURRENT TERTIARY STUDIES ______</p><p>______</p><p>PLEASE LIST SIGNIFICANT TRAINING (completed) ______</p><p>______</p><p>Doc_0543 Applicant Information Summary Reviewed: May 2016 Page 1 of 3 REFEREE INFORMATION</p><p>Please provide contact information of at least two (2) (employment related) referees who may be contacted for a written or verbal reference</p><p>NAME & ADDRESS: ………………………………………………………………………………………………...... </p><p>...... </p><p>OCCUPATION and/or RELATIONSHIP...... …………………………..</p><p>TELEPHONE: (WK) A/H: PERIOD KNOWN: </p><p>NAME & ADDRESS: ...... </p><p>OCCUPATION and/or RELATIONSHIP....COMMUNITY ELDER / MENTOR...... </p><p>TELEPHONE: (WK) A/H: PERIOD KNOWN: </p><p>NAME & ADDRESS: ...... </p><p>...... </p><p>OCCUPATION and/or RELATIONSHIP...... </p><p>TELEPHONE: (WK) A/H: PERIOD KNOWN: ...... </p><p>ELIGABILTY TO WORK</p><p>Are you an Australian or New Zealand citizen?  YES  NO If “NO” (Please attach a copy of documentation confirming eligibility to work within Australia)</p><p>HEALTH AND SAFETY</p><p>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...... ……………………...... ………………...</p><p>...... ………………...</p><p>What is your current employment status? (please circle)</p><p>Unemployed School Tertiary Studying Employed (Casual) (Part-time) (Fulltime)</p><p>I declare that my answer is honest and complete</p><p>APPLICANT’S SIGNATURE: ...... DATE: / /</p><p>Please send this form and your application to:</p><p>TAIHS Human Resources – [email protected]</p><p>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</p>