ABN Support Worker Form
Personal Details
Name
First Name
Last Name
Date of Birth
Gender
Male
Female
Transgender Male
Transgender Female
Non-Binary
Other
E-mail
Mobile Number
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Name of the client you'll be supporting
I have a current Motor Vehicle License and Vehicle
Yes
No
Do you have any special drivers licence conditions or medical conditions that may effect your driving?
Checks and Clearances
Please provide the below checks and clearances by uploading them. You do not need to have all checks and clearances at the time of application (now) but will need these but they will be required to receive payment for services provided. You will also need to sign an Independent Contractor Agreement with My Supports.
NDIS Worker Screening Check
*
Upload a File
Cancel
of
NDIS Orientation Modules
Upload a File
Cancel
of
Driver's License
Upload a File
Cancel
of
Comprehensive Car Insurance Certificate of Currency
Upload a File
Cancel
of
Home and Contents Insurance policy
Upload a File
(only if supports are not at the client’s normal residence)
Cancel
of
Australian Passport, Birth Certificate or VISA proving your right to work in Australia
Upload a File
Cancel
of
Any relevant Qualifications
Upload a File
Cancel
of
Public Liability Insurance
Upload a File
Cancel
of
Submit Application
Should be Empty: