Employment application form

Employment Application Form
Full Name*
Address*
Phone Number:*
Email Address*
example@example.com
Date of Birth*

DayMonthYear
Date
Are you male or female?*

FemaleMale
Do you have any disabilities or conditions that may affect your employment with Mildura Disability Support? If so, please provide details.*
Details of medical conditions or disabilities
Questionaire

If you answer NO to any of the following questions, you are not able to start work with MDS/MAH until you can provide them. If we choose to employ you, we will request these documents and store them on file. They must be provided before employment commences.
Do you have an NDIS screening check?*

YesNo, but willing to obtainNoMy application is pending
What is your NDIS Screening Check Reference or Application Number? *
If you don't have one just say "I do not have an NDISWC"
Have you completed your free online NDIS orientation modules, and can provide a certificate in your name that says "Quality, Safety and You"?*

YesNo
Have you completed your online infection control training?*

YesNo
Do you have a working with children check?*

YesNo, but willing to obtainNoMy application is pending
Do you have a current first aid certificate?*

YesNoNo, but willing to obtain or is booked in
Do you have a current CPR certificate?*

YesNoNo, but willing to obtain or is booked in
Do you have a valid Australian driver's license?

YesNo
More questions

Answering "No" (if applicable) will not automatically disqualify you from employment with MDS/MAH.
Do you have a reliable vehicle?*

YesNo
Is your car comprehensively insured?*

YesNo
Is your car registered?*

YesNo
If you do not have a vehicle, how are you going to get to work?
Are you trained in or willing to do personal care?*

Yes. I am trained in PC.No. But I am willing to be trained to do PC.No. I am not willing to do PC.
Tell us about yourself! What can you offer MDS/MAH?*
What days and times are you available for work? *
Please upload your resume*

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Do you have any relevant qualifications? *
What is your expected hourly rate?*
How many hours would you ideally like to be rostered on for per week?*
I declare that all the information provided in this application is true and correct to the best of my knowledge. I understand that any false or misleading information may result in the termination of my employment.
Applicant Signature*

Clear
Date*

DayMonthYear
Date
Should be Empty:

Questionaire

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