Support Worker Application Form

Your current employment/role (please include the employer name, the date you started, and the position you held)

Your previous employment/roles (please include your last 2 or 3 roles, and please include the employer names, the date you started, the positions you held, and your reason for leaving)

Below, please supply the details (full name, organisation, position, and contact phone number) of 3 work related references. At least 2 of these referees must come from Australian business organisations. Do not include co-workers; referees are to be supervisors only. Please ensure your referees know we are contacting them.

I understand

Reference # 1 (please provide full name, organisation, position, and contact phone number)

Reference # 2 (please provide full name, organisation, position, and contact phone number)

Reference # 3 (please provide full name, organisation, position, and contact phone number)

Please outline your experience of working with people with disabilities

Please outline your experience of working with people with complex behaviours

Do you have a current Blue Card (Working with Children Check)? If so, please advise the expiry date on the card

Do you have a current Yellow Card (NDIS Worker Screening Card)? If so, please advise the expiry date on the card

Do you have an Australian Police Clearance Certificate? If so, please advise the expiry date of the certificate (Please note: This question applies to overseas applicants only)

Do you have a current First Aid certificate? If so, please advise the expiry date of the certificate

Do you have a current CPR certificate? If so, please advise the expiry date of the certificate

Do you have a current Manual Handling certificate? If so, please advise the expiry date of the certificate

Do you have a current Epilepsy Training (including Midazolam) qualification? If so, please advise the expiry date of the certificate

Do you have a Cert III in Individual Support qualification? If so, please advise the date you acquired this

Do you have a Cert IV in Disability qualification? If so, please advise the date you acquired this

Do you have a Assist Clients with Medication qualification? If so, please advise the date you acquired this

Do you have a Recognise Healthy Body Systems qualification? If so, please advise the date you acquired this

Do you have other skills that you could apply to this role (Auslan, Bronze Medallion etc)

Do you have a current Queensland Drivers Licence? If so, please advise the expiry date

Please indicate the days you are available to work:

Please advise if you are only available to work during specific hours on the above days (for example - only available 9:00am to 5:00pm, not available to work early mornings/evenings/overnights etc):

Is there any other info you would like to provide about your availability?

Do you currently have your own vehicle?

Are you prepared to transport participants in your own vehicle?

Do you have current Comprehensive Insurance for your car? If so, please advise the expiry date

Does your car have a current Car Safety Certificate? If so, please advise the date you obtained this

Do you have any previous or current medical condition or restriction, physical or otherwise, which may affect your ability to care for, lift or otherwise support a person with a disability? (Please note - If the answer to this question is Yes, you will need to provide a Fit for Work Assessment from your GP - Please contact our office for a copy of our Fit for Work Assessment form)

Yes No

If yes, please provide details

I declare that to the best of my knowledge, the information given is true and correct

Yes

I understand that inaccurate, misleading or untrue statements or knowingly withheld information may result in termination of my employment with Inclusion Plus

Yes

I understand that this application does not constitute an offer of employment

Yes

I understand that Inclusion Plus reserves the right to verify my qualifications, licences, permits and history checks

Yes

I understand that this application form contains personal information, which will be dealt with in accordance with our Privacy Policy

Yes

I understand that if I am successful in my application, my application form will become an employment record

Yes

I understand that if I am unsuccessful, my application form will be securely destroyed

Yes