Disability Support Worker Application Form

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Extended Families welcomes the rich diversity of our community and strives to be inclusive for all. As an equal opportunity employer, we promote social inclusion and encourage applications from people with disabilities, Aboriginal and Torres Strait Islander people, those from all cultural backgrounds, and people from the LGBTIQ+ community.

Extended Families wholeheartedly commits to creating a culturally safe environment that honours and empowers Aboriginal and Torres Strait Islander children and adults, actively opposes racism, and ensures their full participation and well-being within our organisation. We acknowledge Aboriginal and Torres Strait Islander peoples as the first inhabitants of this nation and the Traditional Custodians of the lands where we live, learn and work.

Extended Families is committed to ensuring the safety, wellbeing, and empowerment of all children. Discrimination is not tolerated, and we treat every child with dignity and respect.
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Full Legal Name:* This field is required.
First Name
Middle Name
Last Name
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Preferred Name:
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Pronouns:
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Email address:* This field is required.
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Current Residential Address:* This field is required.
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Australia
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
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Phone Number:* This field is required.
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Date of birth
Date
Day
Month
Year
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How did you hear about this position?
Extended Families' Website
Indeed
University
University Expo
Instagram
Friend / Extended Families Employee
Facebook
Student Job Board
Linked In
Jora
Ethical Jobs
Seek
Other
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Please list the name of the Extended Families staff member, volunteer or service user you heard about us from.
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If you can speak, read or write languages other than English, please detail below:
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Are you currently authorised to work in Australia?* This field is required.If no, please do not continue with this form
Yes - Permanent Resident or Australian/New Zealand Citizen
Yes - Current Work Visa / Permit
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VISA details:Please include any conditions that may affect your ability to work (ie: maximum number of work hours per fortnight)
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Do you have a illness or injury that may effect your ability to perform this role?* This field is required.
YESNO
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If yes, please provide the details and any current restrictions it may have on your ability to perform the role. Please detail any ways that we might be able to reasonably accommodate your restrictions that would enable you to safely perform the role.
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In the last 10 years, have you served any part of a sentence of imprisonment, or been charged with any offence that has been proven against you?* This field is required.
YESNO
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Have you ever had any disciplinary action taken against you by any current or former employer, including any action that resulted in termination of employment?* This field is required.This includes any finding of improper or unprofessional conduct by any court or tribunal of any kind and any investigations that you have been the subject of by an employer, law enforcement agency or any integrity body or similar in Australia or in another country.
YESNO
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If yes, please provide detail:
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Do you have any reason to believe that you have been excluded from working with people with a disability and may hold an NDIS Worker Screening Exclusion?* This field is required.
Yes, I have reason to believe I have a NDIS Worker Screening Exclusion
No, I do not believe I would be excluded from working with people with a disability and I agree to present or apply for and NDIS Worker Screening Clearance prior to employment
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Does anyone in your immediate family or anyone that you live with, work for Extended Families, or use any of Extended Families' services?* This field is required.
YESNO
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Do you currently work in disability services, either as an employee or as a sole trader with an ABN?* This field is required.
YESNO
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If yes, please provide detail:* This field is required.
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When are you available to work?* This field is required.You can add comments about your availability after clicking NEXT
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6am - 10am
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2pm - 6pm
6pm onwards
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Please add comments about your availabilityIf you have any known holidays or periods of leave coming up, or if your availability doesn't really fit with the selections above, please provide details.
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Available start date:
Date
Day
Month
Year
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Please attach your cover letter here:
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Max. file size: 10.6MB
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Do you agree to present or apply for an NDIS Worker Screening Clearance, an Employee Working with Children Check and a valid First Aid and CPR certificate prior to commencing employment?* This field is required.
YESNO
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Do you agree to present or apply for an NDIS Worker Screening Clearance prior to commencing employment?* This field is required.
YESNO
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Do you agree to present or apply for an Employee Working with Children Check prior to commencing employment?* This field is required.Please note, we cannot accept volunteer checks.
YESNO
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Do you agree to present a valid First Aid and CPR certificate prior to commencing employment?* This field is required.Please note, First Aid is valid for 3 years and CPR is valid for 1 year.
YESNO
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Do you require an International Police Check? You will need to provide one if you have resided overseas for 12 months or more in the last 10 years* This field is required.
Yes, and I am willing to obtain an International Police Check
Yes, and I have an International Police Check
No, I have not resided overseas for 12 months or more in the last 10 years
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Have you completed the NDIS worker orientation module, 'Quality, Safety and You'?* This field is required.
Yes, I can provide the certificate of completion
No, but willing to complete prior to commencing employment
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Do you have a current Driver License? Please note, a valid Driver License is required for this role.* This field is required.
YESNO
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Do you have regular and reliable access to an insured car? Please note, this is a requirement of this role.* This field is required.
YESNO
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Do you accept that you will be responsible for maintaining appropriate car insurance, and that any costs related to vehicle damage, either to your own or those of members of the public will be your responsibility?* This field is required.
YESNO
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QualificationsPlease provide the details of any qualifications that you are currently completing.
Year Expected to Complete
Qualification/Area of Study
Institution
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Completed QualificationsPlease provide the details of any qualifications you hold.
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Employment HistoryPlease list information about your current and past employment (including temporary, part-time and voluntary work) starting with the most recent employment.
Period Employed
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Reason for Leaving
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What made you decide to apply for this position?
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Do you have previous experience supporting people with a disability in an informal, voluntary or paid capacity?* This field is required.
YESNO
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If yes, please describe your experience and the support your provided:
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What do you think your participants might identify as qualities of a great Inclusion Support Worker?* This field is required.
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Maintaining an honest and trusting relationship with your participants is essential to this role. How would you build and maintain professional relationships with the people you support?* This field is required.
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Please describe what you imagine the typical day on the job as an Inclusion Support Worker with Extended Families would look like:
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Work/Professional RefereesPlease nominate three professional referees, with two being direct supervisors or managers. Please note you will be notified before referees are contacted.
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Please attach your resume and any other supporting documents here:Please only upload PDF files.
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Max. file size: 10.6MB
Please only upload PDF files.
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Please make any other comments here, including any further information that may support your application:
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Declaration Summary* This field is required.• I have answered all questions honestly and openly and I have not knowingly withheld any relevant information. • I have read the position description and I understand the inherent requirements of the position for which I am applying. • I acknowledge that failure to disclose this information or providing false and misleading information may result in invoking Section 41 Workplace Injury Rehabilitation And Compensation Act which will dis-entitle me or my dependants from receiving any workers’ compensation benefits relating to any recurrence, aggravation, exacerbation or deterioration of any pre-existing condition which I may have arising out of or in the course of, the employment. • I authorise Extended Families (and their employees and agents) to make such enquiries as considered appropriate to verify the information I have provided as part of this application. • I have no prior injuries, illnesses or medical condition that may recur, deteriorate, be exacerbated or aggravated by the employment. I certify that the information given is a true and accurate statement and I understand that I am liable to have my employment terminated, or my offer of employment withdrawn if any details in the application are found to be falsified or misleading. I declare the declaration summary and all other information provided in this form is true and correct.
YesNo
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You have reached the end of the Inclusion Support Worker Job Application form for Extended Families.

Thank you for taking the time to complete this application.

Extended Families will contact you to discuss your application if you are shortlisted for this role.
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