Name
First Name
Last Name
Date of birth
First Aid / CPR
Expiry Date
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First Aid/ CPR
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Driver's License ID
Please include expiry date and License Number
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NSW Australian Drivers Licence (Front)
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Car registration
(e.g.: QVB 345)
Car Insurance Details
Comprehensive Car Insurance (e.g. NRMA, CGU, AAMI)
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Car Insurance
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Joining Date
When did you join the organisation?
Position
E.g: Support Worker, Mental Health Support Worker, Nurse, Support Coordinator, Administration
I.D type 1
Passport or Birth Certificate. Please include expiry and identification number
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Passport or Photo ID Card
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I.D type 2
Medicare or Student ID Please include expiry and identification number
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Medicare Card, Student ID
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Do you have a secondary job? Please declare if you have a secondary job by indicating Yes or No. If you say yes, please complete the conflict of interest form available in shift care and upload it here.
Yes
No
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Conflict of Interest Form Upload
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Working with Children's Check
Please include expiry and identification number
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Working With Childrens Check
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Police Check
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Upload Police Check
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Email Address
Please include primary email address, this will be used as your username and login for rostering systems, training systems and communication.
Contact Number
Please include contact number, this will be used as your username and login for rostering systems, training systems and communication.
Address
Current home address
Suburb
Availibility
Rows
Start
Finish
Monday
Tuesday
Wednesday
Thursday
Friday
Emergency Contact
Include name, relation to you and contact details
Have you been selected to be an Emergency team member for the organisation?
Have you been identified as an emergency team member for the organisation. E.g: Management, Fire Warden
Do you need to declare a conflict of interest?
Please declare any conflict of interest, this may include you are related to a participant who you're servicing, or in a relationship with a staff member or participant that you're working with.
File Upload - Infection Control Module - Hand Hygiene Module - Qualification's (Age Care, Cert 2 or 3)
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Please upload modules / certifications
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Residency Status
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Upload Right to Work / VISA
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REFERENCE CHECK
Please include two references
Bank details
ACC NO
BSB
Taxfile Number
Super Details
Include Username and Super Fund details
Signature
Continue
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