Application Form

Application Form
Disability Support WorkerRegistered NurseAllied Health (Psychologist, OT, Speech Pathologist)Other (please specify below)
Which role are you applying for?
SeekReferralFacebookLinkedInShield of Care WebsiteOther
YesNo
You must be at least 18 years old to apply for this role. We look forward to hearing from you when you reach this level of life experience!
Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.Format: 0000000000.
Location*

Street Address

Street Address Line 2

CityState / Province

Post Code
EmailPhoneSMS
YesNo
We are not able to employ you at this time. Please re-apply when this has changed.
YesNo
YesNo
0–10km10–20km20–40km40km+
Weekdays (morning)Weekdays (day)Weekdays (afternoon)Weekdays (4pm–10pm)OvernightWeekendsSleepovers / active nights (if relevant)
5–1010–2020–3030+
Immediately1–2 weeks2–4 weeksIn a month or two
YesNo (still apply!)
Briefly describe your relevant experience*
Who have you supported? What setting? What were your main duties?
Personal careManual handling / hoist transfersMedication assistance (non-clinical)Meal prep / domestic supportCommunity accessBehavioural support / positive behaviour support plansMental health / psychosocial supportAutism / ADHD supportComplex communicationSeizure awarenessCatheter / enteral feeding support (only include if you actually want applicants selecting this)
YesSomeNo
Please describe your high intensity experience:
I’m comfortable and trainedComfortable with supportNot comfortable yet
Current (already have it)In progressDon’t have it yet but willing to obtain immediatelyNot willing
CurrentIn progressWilling to obtainNot willing
Current (last 12 months)Older than 12 monthsDon’t have one - Will obtainNot willing
Both currentOne current, one expiredExpired - will get this done as soon as possibleNot willing
Why do you want to work with Shield of Care?*
2-6 sentences
YesNoNeed to discuss
FemaleMaleNon-binaryPrefer not to sayAnother term (please specify)
My gender:
Referee 1 - Name*

First NameLast Name
Referee 1 - Relationship/Role*
Referee 1 - Phone*
Please enter a valid phone number.Format: 0000000000.
Referee 1 - Email (optional but ideal)
example@example.com
Referee 2 - Name*

First NameLast Name
Referee 2 - Relationship/Role*
Referee 2 - Phone*
Please enter a valid phone number.Format: 0000000000.
Referee 2 - Email (optional but ideal)
example@example.com
Yes, any timeYes, but only after interviewNo (please explain)
Reasons my referees can't be contacted at this time
Please upload your resume/CV*

Cancelof
We are sorry, we are unable to offer you employment without the required documentation.
Should be Empty: