HUMAN RESOURCES

Date of Issue Section Document No. Revision No. Page no.

Oct 2013 HR 1.0 HR C1-S1.0-F1 1 Page 1 of 2

Application for Employment Form

PLEASE PRINT ALL INFORMATION REQUESTED AND COMPLETE ALL SECTIONS

A CURRENT RESUME OR CURRICULUM VITAE MUST BE ATTACHED IF NOT ALREADY SUBMITTED

Name:……Dhaliwal ..............Rajwant…………Kaur…… Date:…06/04/1990

Last First Middle Middle

Street Address:.…18, Delias road…………………………………………………………………………….

Suburb/Town……Tarneit.……………………………………...State……Victoria…………….Postcode……3029………………

Telephone ………0449716878…………………………………………… Mobile:…0449716878……………………

Email…………………rajwant_35@yahoo.com……………………………………………………………………………

…………………………………………………………. Advertised:…………………….………………… e.g. The Age, Internet, Employment Agency

Date advertised: …………………………………..

Position applied for:……………PCA……….. Days/hours available to work (morning / afternoon / nights)

No Preference Monday

Tuesday Wednesday

Thursday Friday

Saturday Sunday

Employment desired: FULL-TIME ONLY PART-TIME ONLY FULL OR PART-TIME CASUAL

When are you available to commence work?…as soon as possible……………………………………………….

Do you have a preference for which facility / site you wish to work? Yes No

If ‘yes’ please specify: ……………………………………………………………………………………………………………….

HAVE YOU PREVIOUSLY BEEN EMPLOYED BY DOUTTA GALLA? Yes No

If ‘yes’ please specify when & at which site or facility:…………………………………………………………………………...

ARE YOU AWARE OF THE REQUIREMENT TO UNDERTAKE A CRIMINAL HISTORY RECORDS CHECK TO BE ELIGIBLE TO WORK IN AGED CARE? Yes No

HAVE YOU ALREADY SUBMITTED YOUR RESUME FOR THIS APPLICATION? Yes No

If ‘yes’ please specify where/ to whom: ……………………………………………………………………………………………

HAVE YOU AT ANY TIME SINCE TURNING 16 YEARS OF AGE BEEN A CITIZEN OR PERMANENT RESIDENT OF A COUNTRY OTHER THAN AUSTRALIA? Yes No

ARE YOU CURRENTLY ON A VISA? Yes No

PLEASE INDICATE THE TYPE OF VISA?

Student Spousal Bridging Permanent Other _____________

(PLEASE SPECIFY)

DO YOU HAVE THE RIGHT TO WORK IN AUSTRALIA? Yes No

ARE THERE RESTRICTIONS ON YOUR VISA? Yes No

If you ticked ‘Yes’ please specify any restrictions that apply: 20 hrs per week

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HUMAN RESOURCES

Date of Issue Section Document No. Revision No. Page no.

Oct 2013 HR 1.0 HR C1-S1.0-F1 1 Page 2 of 2

DO YOU HAVE A CURRENT DRIVER’S LICENCE? Yes No

What vehicles are you licensed to drive? ……Car……………………………………………………………………………….

Driver’s licence number:……………………………………… State of issue:…Punjab(India)... Expiration date:…./…/….

PLEASE ADD ANY ADDITIONAL INFORMATION THAT IS RELEVANT TO YOUR APPLICATION

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Did you complete this application Yes No

If not, who did?………………………………………………………………………………………………………………………

DECLARATION - PLEASE READ CAREFULLY

In exchange for the consideration of my job application by Doutta Galla Aged Services I acknowledge that:

I have provided all requested information and responded to all questions.

All details I have provided in this application and the accompanying (submitted) resume / curriculum vitae are true and correct.

I understand that initial and ongoing employment with Doutta Galla Aged Services is subject to my consent to authorize Doutta Galla to undertake a Criminal History Records Check

I understand that my application for employment and/or continuation of employment may be terminated in the event that I am determined to not be eligible to work in Aged Care Services as a result of disclosable offences arising from any Criminal History Records Check

I understand that initial and/or ongoing employment with Doutta Galla Aged Services may require a Pre-Employment Medical Examination be undertaken to ensure I can undertake the inherent requirements of the position(s) for which I have applied..

I accept and agree that Doutta Galla Aged Services Ltd has a drug and alcohol policy and my compliance with such policy is a condition of my employment and/or continuation of employment.

I accept and agree that Doutta Galla Aged Services Ltd has an Employee Code of Conduct & Practice and my compliance with the behavioural standards outlined in therein is a condition of my employment and/or continuation of employment.

I accept and agree that Doutta Galla Aged Services Ltd has a privacy and confidentiality policy and my compliance with such policy is a condition of my employment and/or continuation of employment.

I accept and agree that employment with Doutta Galla Aged Services Ltd shall be subject to both a probationary and qualifying period.

Signature of applicant:…………Rajwant Kaur……………………………………….Date:…20/07/2015………………

Doutta Galla Aged Services is an equal employment opportunity employer. We adhere to a policy of making employment decisions in accordance with the Equal Opportunity Act 1995. Thank you for completing this application form and for your interest in our organisation.

Please return this application to: Human Resources Manager

Doutta Galla Aged Services Ltd. 75 Moreland Street, Footscray 3011