Meercroft - Employment Application

Employment Application

THIS APPLICATION FOR EMPLOYMENT DOES NOT GUARANTEE THAT YOU WILL OBTAIN AN INTERVIEW
The information you provide is the first step in our employment process and will enable us to consider you for positions which may arise from time to time.
If a position becomes available and this application meets our selection criteria, you may be contacted for additional information, interview and to attend a pre-employment medical examination.

The information provided in this application is used for the purpose of our recruitment and selection procedures and to support any subsequent employment offer made to you. We may seek confirmation of details from past employers, referees or other sources.
The details provided remain confidential to our organisation or appointed recruitment agency and will not be provided to any other person.

PERSONAL INFORMATION
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Email*
example@example.com
Gender
Date of Birth*

MonthDayYear
Date
INFORMATION ABOUT THIS APPLICATION
What type of work are you seeking with our organisation? (Tick one or more of the following).

Registered NurseEnrolled NurseExtended Care AssistantReceptionistClericalQualified CookCateringCleaningLaundryMaintenanceGardenerBus Driver
Nursing Registration Number
Required if you chose Registered Nurse or Enrolled Nurse above.
Nurses Registration Number Expiration Date

MonthDayYear
Required if you chose Registered Nurse or Enrolled Nurse above.
Nurses Registration Certificate

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Required if you chose Registered Nurse or Enrolled Nurse above. Cancelof
Extended Care Assistant Certificate

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What type of employment are you seeking?
Do you have any qualifications/certificates relevant to the type of work you are seeking?
Do you have any prior experience relevant to the type of work you are seeking?
Working with Vulnerable People Registration Number*
Expiration Date*

MonthDayYear
Date
NDIS New Worker Induction Module Certificate*

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Working With Vulnerable People Identification*

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Upload a picture of your WWVP card Cancelof
COVID Vaccination Certificate*

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Upload your vaccination certificate Cancelof
PREVIOUS EMPLOYMENT OR WORK EXPERIENCE HISTORY
Name of Most Recent Employer:*
Business Address:*
Position Held:*
Date Left:*

MonthDayYear
Date
How long were you employed?*
Reason for Leaving:*
Please provide details of other previous employers:
Name of Employer:
Business Address:
Position Held:
Date Left

MonthDayYear
Date
How long were you employed?
Reason for leaving
Name of Employer:
Business Address:
Position Held:
Date Left

MonthDayYear
Date
How long were you employed?
Reason for leaving
If not previously employed, please provide details of any previous work experience:
PERSONAL HEALTH INFORMATION
Do you currently or have you ever sought medical attention for pain in your back, neck, arms, shoulders hands or wrists?

YesNo
If Yes please list details
Do you currently or have you ever sought medical attention for pain in your hips, legs, knees, feet or ankles?

YesNo
If Yes please list details
Do you currently or have you ever sought medical attention for any of the following?
Epilepsy, blackouts, fits

YesNo
High or low blood pressure

YesNo
Allergies

YesNo
Heart Complaint

YesNo
Hearing problems

YesNo
Diabetes

YesNo
Hernia, ulcers

YesNo
Headaches (e.g. Migraine)

YesNo
Mental or nervous disorder

YesNo
Sight disorders, eye problems

YesNo
Blood disorders

YesNo
Fractured or broken bones

YesNo
Respiratory problems (e.g. asthma, emphysema)

YesNo
Skin problems (e.g. eczema, dermatitis)

YesNo
Meercroft Care has a smoke free policy. Are you a current smoker?

YesNo
Are you aware of any reason which may prevent you from performing the following tasks?
Wearing vinyl / rubber gloves

YesNo
Write reports and documents

YesNo
Lift heavy objects, make beds

YesNo
Use computers, telephones

YesNo
Use vacuum cleaners, mops

YesNo
Use soaps, detergents, bleaches

YesNo
Wear workplace approved shoes for long periods of time

YesNo
Clean incontinence

YesNo
GENERAL INFORMATION
What is your understanding of Meercroft Care Inc.'s Vision and Mission?
Please list any personal qualities you have which you believe may assist your application.
Please provide details of two people we may contact as referees. They need to be people you have reported to in previous roles i.e. supervisors, managers, team leaders etc.

Employee Referee:
Name:
Current Occupation
Their occupation at the time you worked with this person:
Phone Number

Area CodePhone Number
Email
example@example.com
Employee Referee:
Name:
Current Occupation
Their occupation at the time you worked with this person:
Phone Number

Area CodePhone Number
Email
example@example.com
Upload Resume*

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DECLARATION OF APPLICANT
Signature

Clear
I hereby authorise Meercroft Care Inc to obtain references by speaking with my nominated referees to verify any information relevant to this application.

I certify that the information given in this application is true and complete and I am aware that any inaccurate statements made herein or information deliberately withheld may later jeopardise my employment.

I acknowledge that this application does not constitute an offer of employment and that any offer subsequent to this application will be subject to satisfactory completion of a preemployment medical examination.
Are you an Australian citizen?

YesNo
Do you have a Right to Work in Australia Visa?

YesNo
Upload File for Visa

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Your application cannot be submitted.
Name

First NameLast Name
Date

MonthDayYear
Date
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