VACANCIES AT EREMEA

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Application

First Name

Last Name

Email

Mobile

Resume

Attachment

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Questionnaire

Working Rights
Do you have unlimited working rights in Australia ?

YesNo

Criminal
Have you ever been convicted of a criminal offense in the past 10 years ?

YesNo

Experience
How many years of related experience for this role do you have ?

Reason for Leaving
What is your main reason for leaving your current/previous position ?

Checks
Do you consent to reference checks being undertaken ?

YesNo

Position
How did you hear about this position ?

Driver's Licence
Do you have a valid driver's licence?

Vehicle
Do you have a vehicle?

YesNo

Health Questionnaire
If the Answer is yes to any of the questions on this form, please give full details in the space provide also of the dates, duration and outcomes of the illness or condition. If we have any concerns about your fitness for work, employment will be subject to a satisfactory medical report.

Tuberculosis, asthma, bronchitis or chest problems?

YesNo

Chest pain, heart condition or raised blood pressure?

YesNo

Blackouts, fits or attacks of giddiness?

YesNo

Depression, mental illness or nervous breakdown?

YesNo

Rheumatism or arthritis?

YesNo

Back Troubles?

YesNo

Typhoid or paratyphoid?

YesNo

Digestive or bowel disease?

YesNo

Diabetes, thyroid or other gland trouble?

YesNo

Bladder or kidney trouble?

YesNo

Dermatitis or skin trouble?

YesNo

Varicose veins

YesNo

Any other accident, operation or illness?

YesNo

Have you any reason to believe you may be infected with any communicable disease?

YesNo

Any other current or recent medical condition or treatment which might affect your work attendance or performance at work?

YesNo

Do you intend to work night duties on a regular basis?

YesNo

Has any illness or medical condition prevented you from attending work and completing your normal duties or activities for more than one week during the past one year?

YesNo

Do you have any physical or mental impairment which has a substantial and long term effect on your ability to carry out day to day activities?

YesNo

Do you smoke?

YesNo

How many units of alcohol do you drink per week? (one unit = 1 middy beer = 1 glass wine = 1 shot of spirits)

YesNo

Declaration *By Submitting this application, you declare the information provided in this application is true and correct.

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Personal

Street Address

Suburb

State

Post Code

Support Worker

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Questionnaire

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Support Worker

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