Job Application Form
Please Note: This role is for independent contractors. Applicants must have a valid ABN and current public liability insurance to be considered.
Name
*
First Name
Last Name
Date of Birth
*
-
Day
-
Month
Year
Date
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Emergency Contact
First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Eligibility to Work
Are you an Australian citizen, permanent resident, or have legal working rights in Australia?
*
Yes
No
Visa Type (if applicable)
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Qualifications and Licences
Please provide a valid form of government issued photo ID (e.g. passport, proof of age card, or driver’s licence)
*
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Working with Children Check (WWCC)
*
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National Police Check
*
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NDIS Worker Screening Check
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Relevant Qualifications (e.g., Certificate III or IV in Disability/Aged Care/Individual Support)
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First Aid Certificate (upload copy)
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CPR Certificate (upload copy)
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Other Certifications (eg. Immunisation Cert, NDIS Modules etc.)
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ABN and Insurances
Certificate Of Currency
ABN Number
*
ACN Number (If Applicable)
Public Liability Insurance and Professional Indemnity Insurance (minimum recommended $10 million)
*
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Car Insurance (if using your vehicle for work)
*
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Workers Compensation or Personal Accident Insurance (if applicable)
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Note: All insurances must remain valid while engaged with Platinum Care Disability Services. You may be asked to provide updated copies as required.
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Work Experience
Describe your previous support work or related experience(Short paragraph or bullet points)
How many years of experience do you have working with people with a disability or aged care clients?
Less then 1 year
1-3 years
3-5 years
5+ years
Availability
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Times Available
Morning
Afternoon
Evening
Are you willing to work public holidays?
Yes
No
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Skills and Competencies
Do you have any experience in these fields?
*
Personal care (e.g., showering, toileting)
Meal preparation
Medication assistance
Manual handling/hoist use
Social/community participation
Behavioural support experience (if applicable)
Allied Health Assistance (optional)
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Reference 1
Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Company
Reference 2
Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Company
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Additional Information
Why are you interested in working with us?
Do you have any medical conditions, injuries, or anything that may affect your ability to perform the duties of this role? (Confidential)
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Document Uploads
Resume
*
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Cover Letter
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Declaration and Consent
I declare that the information I have provided is true and correct.
*
Yes
No
I consent to Platinum Care Disability Services conducting relevant background checks (police check, reference check, NDIS Worker Screening verification).
*
Yes
No
Signature:
*
Date
-
Day
-
Month
Year
Date
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