APPLICANT COVER SHEET
We Value: Respect | Communication | Fun & Humour | Pride | Trust | Teamwork
POSITION DETAILS
Position Title
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How did you hear about this vacancy?
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Council Website
Newspaper
Facebook
Other
If, other please specify:
APPLICANT DETAILS
Name
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First Name
Last Name
Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
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example@example.com
Phone Number
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Please enter a valid phone number.
Format: 0000 000 000.
Are you an Australian Citizen?
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Yes
No
If No, do you have permanent residency status?
Yes
No
If you answered 'No' to the two questions please state your work rights within Australia (e.g New Zealand citizen or other visa holder and number):
HEALTH AND SAFETY
This information enables Quilpie Shire Council to fulfil its Workplace Health & Safety Duty of Care obligations. Have you any physical, mental health or emotional condition which should be known to Council in case such conditions may affect you health and safety in particular work situations?
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Yes
No
If yes, please give details:
APPLICANT AGREEMENT
Do you agree to supply original or certified copies of academic qualifications and/or other documentation if required?
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Yes
No
Do you agree for Quilpie Shire Council to contact referees for verification purposes; Police and Commission for Children and Young People for Police History checks and agree to complete approved testing, medical examinations or such other tests as part of any selection process?
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Yes
No
CERTIFICATION
I certify that the information given in this application is true and correct, and that if employed, such information as stated, forms the basis of my contract of employment with Council.
Signature
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Date
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/
Day
/
Month
Year
Date
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