APPLICATION FOR EMPLOYMENT Application FormDate Title Mr Mrs Miss Ms OtherDo you identify as Aboriginal/Torres Strait Islander? Yes NoFirst NameLast NameDate of BirthPlace of birthState/CountryDo you require a Visa to work in Australia? Yes NoEmail AddressMobileHome PhHome AddressSuburbStatePostcodeDETAILS OF EMPLOYMENT **Please provide details below ( at least the last three positions held ) Position #1START DATE OF EMPLOYMENTFINISH DATE OF EMPLOYMENTCOMPANYPOSITION HELD REASON FOR LEAVINGREFEREES / REFERENCE NOMINEESAre you willing for Pure Home Care to conduct reference checks on your behalf? Yes NoReferee #1 (Must be previous employment) Company Person to contactPosition Title: (Previous Manager)Business Phone No.How long have you known Referee #1?EmailREQUIRED DOCUMENTSPlease list and attach any of the below documents that you already have. Required DocumentsRequired Documents Resume NDIS Worker Screening Check First Aid Certificate Working with Children's Check Drivers license Passport or Birth Certificate Vehicle Registration Comprehensive Insurance NDIS Worker Orientation Module - https://training.ndiscommission.gov.au//course/index.php?categoryid=2 Infection Control Module https://www.sentrient.com.au/course/ipc.html Membership / Registration CertificateIf you do not have any of the above documents, would you be willing to obtain them prior to employment? Yes NoQualificationsHave you obtained a Certificate IV or above in a related field to this role? Yes NoPlease list any other qualifications have obtained and if possible attached a copy of the certificate.Please attach a copy of the certificateChoose File QUESTIONS Pure Home Care Pre Employment Health Declaration FormDownload here the pre employment health declaration form herePlease attach a copy of PHC Pre Employment Health Declaration FormChoose File Are you aware of any pre-existing injuries, illnesses or medical health conditions that could impact your ability to carry out the full range of duties of this role? Yes NoAre you comfortable providing personal care to both males and females? Yes NoDo you have a reliable vehicle that you would be willing to transport Clients in? Yes NoDo you have any relations that are employed or support by Pure Home Care? Yes NoAvailabilityAs our Placements operates 24/7, are you willing to work; day shifts (06:30 – 14:30), afternoon shifts (14:30 – 22:30+Sleepover), night shifts (22:30 – 06:30) , weekends and public holidays? Yes NoAre you willing to work in both the Newcastle and Mainland area? Yes NoAre you willing to complete sleepover shifts on a regular basis? (A sleepover shift is where the Staff member sleeps at the placement within a secure room for an 8hour period) Yes NoHow many hours would you ideally want to work per week?Do you have any future holidays or leave scheduled? Yes NoIf successful, when would you be able to start?Please indicate in the bellow table what your availability would be over a fortnightly period?Week 1Monday Day Shift Evening / Sleepover Shift Night ShiftTuesday Day Shift Evening / Sleepover Shift Night ShiftWednesday Day Shift Evening / Sleepover Shift Night ShiftThursday Day Shift Evening / Sleepover Shift Night ShiftFriday Day Shift Evening / Sleepover Shift Night ShiftSaturday Day Shift Evening / Sleepover Shift Night ShiftSunday Day Shift Evening / Sleepover Shift Night ShiftWeek 2Monday Day Shift Evening / Sleepover Shift Night ShiftTuesday Day Shift Evening / Sleepover Shift Night ShiftWednesday Day Shift Evening / Sleepover Shift Night ShiftThursday Day Shift Evening / Sleepover Shift Night ShiftFriday Day Shift Evening / Sleepover Shift Night ShiftSaturday Day Shift Evening / Sleepover Shift Night ShiftSunday Day Shift Evening / Sleepover Shift Night ShiftDrugs and Alcohol in the Workplace - Zero Tolerance PolicyWe have a zero-tolerance policy for the consumption and presence of drugs and alcohol whilst at work. Drug and Alcohol testing will occur and is on a random basis.Do you have any concerns undergoing Drug and Alcohol testing? Yes NoPRIVACY & PERSONAL INFORMATION CONSENTPlease complete the following consent statementI,consent to Pure Home Care collecting and storing the above personal and private information during the application process. This information will only be used for the purpose of determining suitability for the position. This information will not be shared with any external parties and will be stored securely and / or disposed of appropriately following this period. I hereby declare that the information I have provided in this form is true and accurate.SignedUpload E-Signature Here Date of SignatureSubmit
