This Form MUST Be Attached to Each Application for Employment Lodged
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 o
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 o If yes is your card current? YES o
Copy of “Blue Card” attached? YES o
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? o YES o NO
Are you of Australian South Sea Islander descent? o YES o NO
Are you a person from a non-English speaking background? o YES o NO
QUALIFICATIONS
PLEASE TICK YOUR HIGHEST ACADEMIC QUALIFICATION COMPLETED:
GRADE GRADE GRADE TERTIARY QUALIFICATION 1-10 11 12 o
PLEASE LIST TERTIARY QUALIFICATIONS (completed)
______
PLEASE LIST CURRENT TERTIARY STUDIES
______
______
PLEASE LIST SIGNIFICANT TRAINING (completed)
______
______
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? o YES o 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? o YES o 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: / /
Doc_0543 Applicant Information Summary Reviewed: May 2016 Page 2 of 2