EMPLOYMENT APPLICATION AND PERSONNEL PROFILE

ZedCare Ability will flexlect and maintain personal information about an individual. This information will be stored within their personal files. The information that is flexlected about an employee of ZedCare Ability Services will include date of birth, next of kin, banking and financial details, payroll information (superannuation, tax file number), previous employment history, performance management (flexlected during the term of employment) information and contact details. This information is required human resource management, payroll and in the event of an emergency. This information will remain private and confidential. However, disclosure of this information may be required by the Commonwealth Government or its agencies, or other parties for the purpose of assisting in managing the business and regulatory, legislative and Accreditation compliance. Any disclosure of this information will be done in accordance with legislation such as the Aged Care Act 1997 (Cth), Occupational Health and Safety Act 2004 (Vic), Workplace Injury Rehabilitation and Compensation Act 2013, Privacy Amendment (Private Sector) Act 2000, Privacy Amendment (Enhancing Privacy Protection) Act 2012, Privacy Amendment (Notifiable Data Breaches) Act 2017 (Cth) and industrial relations legislation. All payroll, banking and financial information (banking details, superannuation, tax file number) will be required to disclosed to ZedCare Ability Services’s Administration. The purpose of doing so is to ensure that the correct and appropriate earnings of an individual is accounted for and meeting taxation and superannuation legislation.

Tick the box if consent has been provided

I hereby consent to information being flexlected, stored, utilised and disclosed as described above.

Date

Application relating to position:

Full timePart timeCasualTrainee

Surname:

Given names:

Email:

Gender

MaleFemaleOther gender identity

Phone: (M):

Residential Address:

Postal Address (if different from above):

Date of birth:

Place of Birth (town/country):

Entitlement to work

Australian CitizenNaturalised AustralianPermanent ResidentWorking VisaStudent VisaOther

Are you prevented from lawfully being employed in Australia because of your visa or immigration status?

YesNo

Next of Kin

Relationship:

Surname:

Given name:

Address:

Phone: (BH)

(AH)

Mobile:

Qualifications and Training: Provide CV/resume

Other skills:

Languages spoken:

I have a valid Police CheckI have applied for a Police Check:

I have NDIS workers screening check

I have WWC

I have done covid-19 Infection-control Training

I have done NDIS workers Orientation Module

Signature of Applicant:

Date:

Employment Information

If you have submitted a CV/resume with this application that includes the requested information below, do not complete this section. If not, please list all your employment for the past five (5) years beginning with your present job or last job held. If you need additional space, continue on a plain sheet of paper.

Are you currently employed?

YesNo

If yes, may we contact your employer?

YesNo

Please provide a contact person and telephone number:

Disclosure of Pre-Existing Injury

Under the Workplace Injury Rehabilitation and Compensation Act 2013 (Vic), Section 41, applicants for employment must, prior to the commencement of employment, be advised in writing and must disclose in writing the following:

• The nature of the work to be undertaken i.e.; Position Description must be provided for your information by the potential employer

• That you are required to disclose all pre-existing injury/ies and disease/s, which may be affected by the nature of the proposed employment.

• That if you make a false or misleading disclosure or non-disclosure you (the worker) would not be entitled to compensation in certain circumstances

• If you fail to disclose or make a false and misleading disclosure then any recurrence, aggravation, acceleration, exacerbation or deterioration of the pre-existing injury or disease does not entitle you to compensation.

As a means to ensure both your and our compliance with the Act mentioned above, you are asked to complete the following questionnaire:

I have read the summary of Workplace Injury Rehabilitation and Compensation Act 2013, Section 41, as presented above and understand and accept its requirements.

Signature of Applicant:

Date:

Do you have pre-existing injuries?

YesNo

If yes, please provide details:

How did these injury/ies and /or disease/s occur?

Have you received a position description describing the nature of the work to be undertaken in the role for which you have applied?

YesNo

In your opinion, do you feel this injury/ies and/or disease will affect your ability to fulfill the requirements of the position you have applied for as described in the position description?

YesNo

UNDERSTANDINGS AND AGREEMENTS

1. The duties and requirements of the position for which I have applied have been outlined and are understood.

2. I understand that any misrepresentation, falsification or omission in this application shall be sufficient reason for refusal or dismissal of my employment. I hereby authorise investigation of all matters contained in this application and agree that if the results of such investigation are not satisfactory, any offer of employment made by or employment with <ZedCare Ability Services> may be terminated immediately. I agree to conform and adhere to the rules and regulations of <ZedCare Ability Services> Further, I understand and agree that this application and any other materials I may receive are not intended to be, nor shall be construed to be an offer of employment.

3. I also give permission for <ZedCare Ability Services> to contact my nominated referees.

Signature of Applicant:

Date: