EMPLOYMENT APPLICATION FORM

This is a standard application form for employment with Somerville Community Services Incorporated.  This application form must be completed fully and as accurately as possible.  It is essential for the processing of your application for employment that all questions are answered.  Should you be successful in gaining employment with us, our policy is that all employees are required to serve a minimum probationary period of three (3) months.  Each applicant must accept that no guarantee of employment is given by the completion of this form.  The information on this form will be used for employment purposes only.  We will not use nor disclose this information for any other purpose without your written consent.

POSITION APPLIED FOR:    

Permanent:   Casual:

1.  PERSONAL DETAILS:

Surname:   First Name:

Title:  Mr/Mrs/Miss/Ms/Dr              

 
Current Address:

Street:   

Suburb: 

State:   
  

P/Code:

Postal Address (if different from current address): 

Street:   

Suburb:

State:    
           

P/Code:

Date of Birth:   

(optional) 

Phone - AH:   BH:  Mobile:     

Email Address:  

Driver's Licence:      Class:     State:

Are you legally entitled to work in Australia?  No Yes 

If yes, do you have any work restrictions?  No Yes    

Please specify:

2. EDUCATION

Please attach Resume, recent work references and other documentation to support your application including relevant certificates and academic transcript. Attach these documents to your application by browsing to where they are saved on your computer using the browse buttons at the end of this form.

3.  EMPLOYMENT HISTORY (INCLUDING CURRENT EMPLOYMENT)

4.   Do you have any physical condition which may affect your ability to carry out the duties of this position?  If so please give details (please answer each question).

      a) Back? No Yes  please specify:
      b) Neck? No Yes  please specify:
      c) Other? No Yes  please specify:

5.  Have you previously taken or are you currently taking medication which could affect your
     work performance in line with the relevant duties and responsibilities statement?

    No Yes 
     If yes, please specify :

6.  Have you ever sustained an injury whilst previously employed.   No Yes 

    If yes, would this injury affect your ability to carry out the duties of this position in any way?

      
     No Yes      

    If yes,  please specify: 

7.  Do you have a health problem, disability, serious illness, impairment or handicap which  
     could affect your work performance in line with the relevant duties and responsibilities?

     Please answer each question.  If yes, please give details.

     Health Problem?

     No Yes  please specify:

     Disability?

     No Yes  please specify:

     Serious Illness?

     No Yes  please specify:

     Impairment?

     No Yes  please specify:

     Handicap?

     No Yes  please specify:

     Other?

     No Yes   please specify:

8.  Will you agree to undergo a medical examination if requested ?  No Yes 

9.  Have you previously applied for a position or worked at Somerville Community Services Inc?        No Yes  please specify:

10. Do you have a current First Aid Certificate? No Yes  please supply copy.

11. Give details of any interests, activities or special skills which may support your application.

12. DISABILITY SERVICES ONLY
 
 Please number boxes 1 – 4 in order of preference.

Permanent Full Time:

  76 hrs per f/night (4-5 week rotating roster doing Early and Late Shifts)

Permanent Part Time:
45.6 hrs per f/night doing Early and Late Shifts

Permanent Night Shift:
63 hrs per fortnight doing Night Shifts only

Casual:
  Any shifts, please tick your availability below

Are you available to work at Howard Springs?   No Yes 

13. Please provide the name, organisation and phone number of at least two work related referees, including your most recent supervisors/managers, from whom we may obtain further information about your application.  Please note, referee checks may be conducted at any point during the application process.

14. Please note that a current Criminal History is a requirement of this position and to be completed at your own expense.

15. In which publication or medium did you see the job(s) advertised?
      Memo                Notice Board                                  Newspaper
      Website             Friends/Family/Organisation        
      Others, specify:

DECLARATION BY APPLICANT

I declare

1. that the answers to this application are, to the best of my knowledge, true and correct in every way.

2. that if my application for employment is successful I will be bound by, and will at all times observe and respect, such terms and conditions of my employment and such policies and rules as may from time to time be promulgated, specified or otherwise stipulated by my employer.

3. that I understand that any erroneous or false declarations made by me in this application may result in disciplinary action or possible dismissal.

Applicant’s Signature:           Date: 

Somerville Community Services Inc is an equal opportunity employer providing a smoke free environment and is committed to the safety of children.

Somerville Community Services Inc strives to accommodate special needs of employees in the workplace.

Please browse to your resume (using the browse buttons below) on your computer so that it can be attached and submited along with the form you just filled out. Another file may also be attached to your application.