Expression of Interest: Aboriginal Cultural Heritage Survey Monitoring

Expression of Interest: Aboriginal Cultural Heritage Survey Monitoring

In order to complete the form, all sections must be filled in! Please contact YSRC Heritage Team if you need guidance on a specific section on 9934 6890.
Section 1: Contact Details
Name*

First NameMiddle NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
example@example.com
Phone Number
Please enter a valid phone number.
Please Note:

You will need to declare all earnings to the Tax Office and lodge a Tax Return to receive any refund of tax. You will also receive superannuation contributions; please note you will need to let us know where you would like this to be paid.
Please select which CULTURAL COMMITTEE you identify with:*

Hutt RiverMullewa WadjariSouthern YamatjiWidi Mob
Do you identify with any other groups?*

YesNo
If yes, please specify:
Is there a particular part of the country with the Agreement Area that you are most strongly connected with? If so, where? e.g. Northampton, Geraldton etc. Please list any specific towns/areas that you have a connection with.
If you have the following qualifications or tickets, please provide details (Card Number)

White CardSenior First AidDriver's License
Add card numbers below:
I have a roadworthy/reliable vehicle:

YesNo
Please list any previous survey and monitoring completed:
Monitoring and Surveys

We will try to coordinate surveys and monitoring at least 2 weeks prior to the date.
Monitoring:*

I wish to be considered for daily monitoring OROngoing 1+ days monitoringI am available Monday - FridayI am available Weekends
Please choose surveying options:*

I wish to be considered for surveysI wish to be considered for (1-2 day) surveys OROngoing surveys (3-7 days)I wish to be considered for December and January (Christmas shutdown monitoring list)
Health and Fitness
Have you or are you currently experiencing any of the following? If you have ticked any of the conditions, you will need to consult your healthcare practitioner for a clearance to work.*

Lung ConditionHeart ConditionHigh Blood PressureChronic Kidney DiseaseChronic FatigueArthritisNone
Any other health requirements or needs that may require support whilst undertaking work?*
Are you currently taking any prescribed medication? If YES, please discuss with you health care practitioner for clearance to work).*

YesNo
Do you have the ability to walk 10km per day? This is 2.5 hours of continuous walking over a period of a 7.6 hour day survey.*

YesNo
I acknowledge that I may be subject to breath testing for alcohol/drugs on site.*

YesNo
Please note that this information is held in the strictest of confidence and in line with our privacy policy. Please be open and honest as much as possible. As a contractor or employee of YSRC and Sticks & Stones Cultural Resource Management, you could put yourself or other people's safety at risk if there is any reason why you cannot do this job and potentially impact future opportunities for others.
Consent and Declaration
Photo Consent*

YesNo
By selecting YES, you consent and grant permission to Yamatji Southern Regional Corporation (YSRC) for the use of any photograph(s), electronic media or video images as identified with monitoring for all marketing and educational presentations of any kind whatsoever.

I understand that I may revoke this authorisation at any time by notifying heritagemailbox@ysrc.com.au in writing. The revocation will not affect any actions taken before the receipt of this written notification. Images will be stored in a secure location and only authorised staff will have access to them. They will be kept as long as they are relevant and after that time destroyed or archived.
Declaration*

I hereby DECLARE that the information provided by me in this expression of interest form for Aboriginal Cultural Heritage Survey Monitoring is true and correct. No information that would have any effect on my application has been withheld.
Name

First NameLast Name
Emergency Contact Name and Phone Number*

First NameLast Name
*
Please enter a valid phone number.
Emergency Contact Relationship*
Signature

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Expression of Interest: Aboriginal Cultural Heritage Survey Monitoring

Section 1: Contact Details

Please Note:

Monitoring and Surveys

Health and Fitness

Consent and Declaration