Application for Employment – Saint Nicholas Aged Care

1. Personal Details

PREFIX

MRS

MISS

OTHER

Given Name(s)*

Surname*

Preferred Name

Address*

Street Address City State / Province / Region ZIP / Postal Code Country

Email*

Mobile*

Landline

2. Position Details

Position Applying For:

Status

Any

Full Time

Part Time

Casual

Temporary

Days Available*

Any

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

Times Available*

Any

Morning

Evening

Night

3. Residency

1. Country of Birth*

2. English as first language*

Yes

3A. Are you an Australian Citizen?*

Yes

3B. If No, where do you hold Citizenship?*

3C. Do you hold permanent Australian Residency status?*

Yes

3D. Please provide your Visa Details*

Holiday

Student

Temporary Skill Shortage (TSS)

Other

Visa Expiry Date*

DD slash MM slash YYYY

3E. Does your Visa place any work restrictions on you?*

Yes

Provide Details?*

4. Employment History

4A. What is your current employment status?

Employed

Self Employed

Unemployed

4B. Have you previously worked for Saint Nicholas Aged Care?

Yes

If Yes, please provide details on position and dates

4C. Have you previously applied for work at Saint Nicholas Aged Care?

Yes

4D. Have you any family members living or working at Saint Nicholas Aged Care?

Yes

If Yes please provide details

4E. Please provide your previous employment history in the table below, starting with your current or most recent position

Start Date

End Date

Company Name

Position

Reason for Leaving

5. Education and Qualifications

5A. Have you completed Year 10 or equivalent education?*

Yes

If No, What level did you achieve?

5B. Please provide details on any other qualifications:

Qualifcation

Institution

Date of Achievement

5C. Other Qualifications being pursued:

Qualification

Institution

Proposed date for completion

5D. Registration Details - For occupations requiring formal registration for employment:

Type of Registration (e.g. Nursing)

Expiry Date

6. Referees

Please provide details of two referees. Your nominated referees should be your supervisor in your current or most recent working environments and where possible, provide information relevant to the type of role for which you have applied.

By completing this section, you are giving permission for Saint Nicholas Aged Care to contact your nominated referees to provide information relevant to your application.

Name

Position

Organisation

Working Relationship to you

Telephone Contact

Name

Position

Organisation

Working Relationship to you

Telephone Contact

7. National Criminal (Police Clearance) History Check

Employment in aged care requires a National Criminal History Check (Police Clearance) to be obtained as required under the Aged Care Act 1997.

If offered employment with Saint Nicholas Aged Care this will be subject to you completing the required documentation to enable Saint Nicholas Aged Care to process an electronic Police Clearance.

A criminal record does not necessarily disqualify an applicant. If rejection of your application is considered solely because of a criminal record, you will be given the opportunity to discuss the matter fully and confidentially with a senior member of staff before a decision is made.

7A. Do you have any convictions for any offences from any court?*

Yes

If Yes, Please Provide Details

7B. Do you have any charges pending before any court?*

Yes

If Yes, Please Provide Details

7C. Are your prepared to complete the required national criminal history check prior to accepting and commencing employment with Saint Nicholas Aged Care?*

Yes

8. Mandatory Vaccination Check

Employment in aged care requires Mandatory Vaccination check to be obtained as required under the Aged Care Act 1997.

If offered employment with Saint Nicholas Aged Care this will be subject to you providing an official vaccination record indicating you have been fully vaccinated for:

Current annual Influenza (Flu) Vaccination
COVID Vaccination

8A. Have you received the current annual Influenza vaccination?*

Yes

If yes, please provide copy of the vaccination certificate

Drop files here or

Accepted file types: jpg, jpeg, png, pdf, Max. file size: 8 MB.

8B. Have you been fully vaccinated for COVID (2x Doses + 1x Booster)?*

Yes

If yes, please provide copy of the vaccination certificate

Drop files here or

Accepted file types: jpg, jpeg, png, pdf, Max. file size: 8 MB.

8C. You answered No to one of the above questions - would you be agreeable to complete the required vaccination/s prior to accepting and commencing employment with Saint Nicholas Aged Care?*

Yes

9. Evidence of Work Rights Status

Please complete Section A or B

A. Australian Citizen (Including New Zealand)
Please provide the original of one of the following documents to be copied and sighted:

Passport

Birth Certificate - plus photo ID e.g. Driver’s licence

Citizenship Certificate - plus photo ID e.g. Driver’s licence

B. Non-Australian Citizens (excluding New Zealand)
Please complete the following: (As specified in passport or other identity document)

Family Name:

Given Name(s):

Other Name(s) E.G. Maiden Name

Date of Birth

DD slash MM slash YYYY

Nationality:

Passport Number:

VISA Number:

Visa Expiry Date:

DD slash MM slash YYYY

Employee Signature

I authorise the department to release the details of my work rights status (that is, my entitlement to work legally in Australia) to Saint Nicholas Aged Care.

I understand that these details are held on departmental files and computer systems. I further understand Saint Nicholas Aged Care will use this information for the purpose of establishing my legal entitlement to work in Australia, and for no other purpose. I also understand that I allow release of my work rights for the duration of my employment with Saint Nicholas Aged Care.

I declare that the information I have provided is true and correct to the best of my knowledge and belief

Todays Date

DD slash MM slash YYYY

Declaration

I declare that the statements I have made and the information I have given are true to the best of my knowledge and belief.
I have not withheld any relevant information required by this application, or made any false or misleading representations.
I acknowledge that if I have knowingly or wilfully given false or misleading information or have withheld any information, it could result in:

1. Rejection of my application;
2. Legal proceedings against me; or
3. Dismissal after appointment.

I understand that appointment to Saint Nicholas Aged Care is conditional upon production of proof of identity, proof of residency status and a current satisfactory national police clearance.

Employee Signature*

Todays Date*

DD slash MM slash YYYY

1. Personal Details

2. Position Details

3. Residency

4. Employment History

5. Education and Qualifications

6. Referees

7. National Criminal (Police Clearance) History Check

8. Mandatory Vaccination Check

9. Evidence of Work Rights Status

Please complete Section A or B

Declaration

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