Online Job Application Form

This form is intended to collect all the relevant information we require when hiring new staff. Please take time to enter all the information you can as best you can, as this helps us in the overall selection process.

Note: All the information provided will be treated in confidence and will not be shared with any other party as described in our Privacy Policy

What is your Full Name?
Full Name
What is Your E-Mail Address?
Your Email
Your Date of Birth:
D.O.B.

Gender
What is your home address?
Home Address (required)

Post Code (required)
What are your Telephone Numbers?
Phone (required)

Mobile

Answering Machine?	Yes No
Where were you born and what languages can do you know?
Country of Birth

Languages Spoken
What is the Best Time to Contact You?
Best Time
What are your Transportation Arrangements?
How do you Travel?	Car Motorcycle Bicycle Public Transport Other

Hold a Drivers License?	Yes No

Driver License Type	Manual Automatic Other

Car Type	4 Cylinder 6 Cylinder 8 Cylinder Other
Do you have comprehensive Insurance on your car?
Comprehensive Insurance	Yes No
Who is your Comprehensive Insurance with?
Insurer
What is the Policy Number of your Insurance Policy?
Policy Number
Please tell us when you would be available.
Availability Monday	Early AM Morning Afternoon Late PM Evening Overnight
Please tell us when you would be available.
Availability Tuesday	Morning Afternoon Late PM Evening Overnight
Please tell us when you would be available.
Availability Wednesday	Morning Afternoon Late PM Evening Overnight
Please tell us when you would be available.
Availability Thursday	Morning Afternoon Late PM Evening Overnight
Please tell us when you would be available.
Availability Friday	Morning Afternoon Late PM Evening Overnight
Please tell us when you would be available.
Availability Saturday	Morning Afternoon Late PM Evening Overnight
Please tell us when you would be available.
Availability Sunday	Morning Afternoon Late PM Evening Overnight
Ideally, how many hours per week would you like to work?
Ideal hours of work per week
Are you happy to work short shift (e.g. 1-2 hours)?
Short Hours	Yes No
Which of these Personal Care Skills do you have Experience or Training in?
Experience	Bathing - Bath - Shower - Bedbath Shaving Grooming Dressing Lifting/Transferring Toileting Drainage - Condom - Colostomy - Illiostomy Respiratory Care eg ventilator Exercise Programs Assist with Communication Aids Bowel Care Correspondence Banking Shopping Other - pls specify
Which of these Personal Care Skills are you willing to learn?
Willing to Learn	Bathing - Bath - Shower - Bedbath Shaving Grooming Dressing Lifting/Transferring Toileting Drainage - Condom - Colostomy - Illiostomy Respiratory Care eg ventilator Exercise Programs Assist with Communication Aids Bowel Care Correspondence Banking Shopping Other - pls specify
Which of these Personal Care Skills are you NOT willing to do?
Will Not Do	Bathing - Bath - Shower - Bedbath Shaving Grooming Dressing Lifting/Transferring Toileting Drainage - Condom - Colostomy - Illiostomy Respiratory Care eg ventilator Exercise Programs Assist with Communication Aids Bowel Care Correspondence Banking Shopping Other - pls specify
Please specifiy any additional comments with regards to your Personal Care Skills
Other Comments
Which of these Household Duties do you poccess Experience or Training in?
Household Duties Experience	Meal Preparation Cooking Meal Assistance Dishes Vacuum Sweeping Dusting Light Cleaning - Kitchem - Bathroom Bed Making Laundry Ironing Light Outdoor Jobs Maintenance of Essential Aids and Equipment Other (please specify) Recreation Socialising Movies/Shows etc
Which of these Household Duties are you willing to recieve Training in?
House Duties Willing to Learn	Meal Preparation Cooking Meal Assistance Dishes Vacuum Sweeping Dusting Light Cleaning - Kitchem - Bathroom Bed Making Laundry Ironing Light Outdoor Jobs Maintenance of Essential Aids and Equipment Other (please specify) Recreation Socialising Movies/Shows etc
Which of these Household Duties are you NOT Willing to Do?
House Duties Will Not To Do	Meal Preparation Cooking Meal Assistance Dishes Vacuum Sweeping Dusting Light Cleaning - Kitchem - Bathroom Bed Making Laundry Ironing Light Outdoor Jobs Maintenance of Essential Aids and Equipment Other (please specify) Recreation Socialising Movies/Shows etc
Please specifiy any additional comments with regards to your Household Duties Skills & Experience
Household Duties Comments
Please list your personal interests or Hobbies to assist us in matching to our clients:
Your Personal Interests & Hobbies:
Are you prepared to have a medical examination to confirm your fitness to work?
Medical Exam	Yes No
Please provide your current work and/or study details.
Current Work/Study
Please provide details of relevant Qualifications or Training you posses
Qualifications / Training
Have you previously worked as an Attendant Care Worker?
Attendant Care Experience	Yes No
If Yes, Please provide details (including organisation and period of employment):
Attendant Care Experience Details
If no, please provide details or any other work / experience that you believe to be relevant to your work as an Attendant Care Worker:
Other Relevant Experience
Why have you applied for work as an Attendant Care Worker?
Why Attendant Care
What would you see as your main role as an Attendant Care Worker?
What Role
Please provide details of your previous employment:
Previous Employment #1	Period of Employment: Place of Employment: Address & Telephone Number: Position you Held: Reason for Leaving:
Please provide details of your previous employment:
Previous Employment #2	Period of Employment: Place of Employment: Address & Telephone Number: Position you Held: Reason for Leaving:
Please provide details of your previous employment:
Previous Employment #3	Period of Employment: Place of Employment: Address & Telephone Number: Position you Held: Reason for Leaving:
Please provide your referee details:
Referee #1	Name: Phone Number: Business/Organisation & Address: Position Held:
Please provide your referee details:
Referee #2	Name: Phone Number: Business/Organisation & Address: Position Held:
Please provide your referee details:
Referee #3	Name: Phone Number: Business/Organisation & Address: Position Held:
Any other information that you feel may assist us with your application?
Additional Information
A police check is mandatory by law for all prospective Attendant Care Workers. Do you have a current Police Check ?
Police Check	Yes No

If Yes, Please give details:
A Working with Childrens Check is mandatory if you are working with children. Do you have a current Working with Childrens Check ?
Working with Childrens Check	Yes No

Childrens Check Details
I declare that the information I have provided is true and correct. I understand that if it is found that I have knowingly provided false information then my application may be rejected or my employment may be terminated.
Declaration	Yes No
Date:
Current Date
Please Note: You should PRINT a copy of this form before you press the SEND button. Use your Browser FILE / PRINT menu option. DO NOT use the PRINT button on the top of this page, if you do you WILL LOOSE YOUR DATA.