Support Workers Application Form - Goodwill Nursing Care

Support Worker Application Form

Pre Employment Collection Form

Application for Employment as

Disability Support Worker

Care Coordinator

Support Coordinator

Other

Preferred nature of employment

Full time

Part time

Casual

When could you commence employment?

Preferred Title

Your Name(Required)

Email(Required)

Mobile(Required)

Your Address

Street Address Address Line 2 City ZIP / Postal Code

Criminal History

In accordance with the state and Commonwealth legislation all staff and volunteers of this organisation will undertake Criminal History Screening. Note: A criminal record is not a barrier to the consideration of an application for employment. Applicants who have a record of conviction are invited to discuss its relevance or otherwise to the position being applied for with the interviewing panel.

In the past 10 years, have you been convicted by a court of any criminal offence or are you currently the subject of a charge pending before any court which could impact on your employment with this organisation?(Required)

Yes

If Yes, Please give details

Note: A criminal record is not a barrier to the consideration of an application for employment. Applicants who have a record of conviction are invited to discuss its relevance or otherwise to the position being applied for with the interviewing panel.

Resonable Adjustment

Do you know of any medical reason why, if appointed, you would be unable to carry out the full requirements of the position? If yes, please give details:(Required)

Yes

If Yes, Please give details

What reasonable actions could the organisation take to assist you perform the job (eg., reasonable modifications to work station, work equipment or work conditions)?

Note: A medical condition or impairment is not a barrier to your employment with this organisation. The information ensures you are placed in an appropriate job or provided appropriate duties. If the above information is found to be false we reserve the right to take disciplinary action including possible termination.

Pre-Employment Collection Statement(Required)

I have read and understood each of the statements in this Collection Statement and voluntarily consent to Personal and Sensitive Information about me being collected, used and disclosed by the organisation as indicated below

Pre-Employment Collection Statement
This organisation respects your privacy. This
statement explains how we collect, use and disclose information during the pre-employment recruitment and selection process.

What is personal information?
Personal information is any information or an opinion (whether true or not) about you. If may range from the sensitive (e.g. medical history or condition) to the everyday (e.g. address and telephone number). It includes the opinions of others about your work performance (whether true or not), your work experience and qualifications, test results and other information obtained by us in connection with your possible employment. Personal information includes sensitive information which can, in most cases, only be disclosed with your consent.

Who will be collecting your personal information?
This organisation or a nominated contractor involved in the recruitment process will collect your personal information for the organisation’s own use in connection with your potential employment.

How your information will be collected
Personal information will be collected about you when we receive:
• Your resume, completed application cover
sheet or application form and any other
information in connection with your application
• Information in the course of an interview
• References or results of enquiries that we might make of your former employers, work
colleagues, professional associations or registration bodies.

• Results of competency tests or medical
examination
• Information you disclose about any workplace
injury or accident, insurance investigation,
litigation, disciplinary matter, criminal matter,
inquest or inquiry in which you are involved
• Any additional documentation you provide
about yourself.

How will your information be used?
Your personal and sensitive information may be used in connection with:
• Your possible or actual employment
• Any test or assessment that you might be
required to undergo
• Any matter considered necessary during the
pre-employment stage or any ongoing
purposes of the employment relationship.

Who may your personal and sensitive information be disclosed to?
• This organisation and its related entities as a
potential and actual employer
• Referees
• Our insurers or a workers compensation body
• A professional association or registration body
that has a proper interest in the disclosure of
your personal and sensitive information
• Our contractors and suppliers who may be involved in the recruitment and selection process
• Any person or organisation with a lawful entitlement to obtain the information.

What happens if you do not give us the
information we seek?
If you do not give us the information we may be limited in our ability to consider you for suitable employment.

How can you gain access to your information to
correct it if it is wrong?
With limited exceptions, you have a right to see and have a copy of personal and sensitive information about you that we hold. If you are able to establish that it is not accurate, complete and up to date you may ask us to place with the information a statement by you to that effect.

Name(Required)

Date(Required)

PRE-EMPLOYMENT MEDICAL DECLARATION

Employment with Goodwill Nursing Care is conditional on the applicant being suitable for employment and able to perform the inherent requirements for the position, subject to any reasonable adjustments. When completing the health declaration, you as an applicant for employment must do so in the full knowledge of the position as advised to you, or as outlined in the relevant role statement/selection criteria. The primary purpose of this pre-employment health declaration is to assist Goodwill Nursing Care to ensure that no person is placed in an environment or given tasks that will result in physical or mental harm. It will also assist Goodwill Nursing Care to take appropriate and reasonable action to ensure the employee’s wellbeing, including identifying any reasonable adjustments that we need to make to allow the employee to perform the role. It is not the intention of the pre-employment health declaration to deny a person employment solely because of disability, illness or injury. You are required to disclose to Goodwill Nursing Care any pre-existing illness, disease, injury, aliment or condition that you have suffered or continue to suffer of which you are aware and could reasonably be expected to foresee, that could impact, or be impacted by the nature of the proposed employment.

Privacy

Goodwill Nursing Care takes your privacy seriously. All details provided on this form are treated confidentially. The completed health declaration form will be retained on your personnel file, which is kept secure at all times. Where employment is not taken up, for whatever reason, all documents relating to your application will be retained for six months and then destroyed. Goodwill Nursing Care and its employees may use the information in your health declaration for the purpose of assessing your suitability for employment as a Support Coordinator. Further Goodwill Nursing Care may disclose that information to its legal advisers for the purpose of obtaining legal advice concerning your health declaration, and any legal proceedings in which your health declaration is relevant. Should any circumstances change that may affect your capacity to perform the inherent requirements of the position that you are undertaking, you are obliged to inform your respective principal or manager.

Section 2 – Status of Health

Are you aware of any circumstances regarding your health or capacity to work that would interfere with your ability to perform the duties of the position?

In answering this question Yes or No you are also covering factors such as: existing or exposure to infectious diseases, taking of medication/treatment on a regular basis (daily, weekly, monthly).

Yes

If yes, please provide details below and feel free to suggest any reasonable adjustments we can make to assist you.

Do you have an existing injury or condition or pre-existing injury or condition that may impact your ability to perform the inherent requirements of this role?

Existing is a condition for which treatment is still being received. Pre-existing is where an injury or condition/s is present but treatment is not required. If yes, please provide details of the injury or condition(s).

Yes

If yes, please provide details below and feel free to suggest any reasonable adjustments we can make to assist you.

Section 3 – Declaration

I do solemnly and sincerely declare that the contents of this form are true and correct in every particular, and make this solemn declaration conscientiously believing the same to be true and correct. I am aware that rendering or making a false declaration may result in risks to work health and safety and accordingly, any wilfully incorrect or misleading answer or material omission may make me ineligible for employment, or if employed, liable to dismissal. The information stated is true and complete to the best of my knowledge and no information concerning my past or present state of health has been withheld. I hereby agree to undergo a health assessment by a medical practitioner if deemed necessary by Goodwill Nursing Care, or to allow my nominated medical practitioner to disclose information relevant to the inherent requirements of this role if required. I am aware that I may be required to undergo a health assessment or testing. I understand that this pre-employment health declaration may form part of my file.

Declared By – Full Name(Required)

Place of Declaration

Date(Required)

APPLICATION FOR EMPLOYMENT

APPLICANTS’ PERSONAL DETAILS:

Name

First Last

Gender(Required)

Female

Male

Other

Date of Birth(Required)

Mobile(Required)

Email(Required)

Are you Australian Citizen or Permanent Resident?(Required)

Yes

If No, Please Specify Your Visa Name, Expiry Date and Status

Do you identify as

Aboriginal or Torres Strait Islander

Neither Aboriginal Nor Torres Strait Islander

Other

Do you have a Driver’s License(Required)

Yes

As a part of this role, you are required to have a Valid Driver License to drive in Australia.

Licence No.(Required)

Expiry Date(Required)

Please Enter Your Tax File Number (TFN)(Required)

Bank Account Details

Please Double Check the Bank Account Details, we will not be responsible if your account details are entered wrong.

BSB Number(Required)

Account Number(Required)

EMERGENCY CONTACT DETAILS:

Name(Required)

First Last

Relationship(Required)

Mobile(Required)

Employment History

Your Employment History

Organisation Name

Position

Date Range

Please add all your working history in this table. You can keep adding more by Clicking on “+” Icon on right side

Any Incidents that occurred that you would like Goodwill Nursing Care to be aware of?(Required)

Do you have a history in Disability/social work/Individual Support?(Required)

Yes

Please list it down below with references.

Organisation Name

Position

Date Range

Contact Person

Contact Number

Goodwill Nursing care requires 100 points of identification (Attachment required)(Required)

Curriculum Vitae (CV)

Valid Photo ID/Passport

Academic Certificate

Valid Police Check

Valid Driving Licence

Citizenship

Medicare card

Please select the one which you have available

Please upload all the files that you have ticked(Required)

Drop files here or

Max. file size: 256 MB.

Goodwill Nursing Care requires from their staff a valid(Required)

Police check

First Aid

Working with children check

100 points of identification

NDIS Worker Orientation Module

Please select which you have available

Please upload all the files that you have ticked(Required)

Drop files here or

Max. file size: 256 MB.

NDIS Code of Conduct

Goodwill Nursing Care promote safe and ethical service delivery, by setting out expectations for safe and ethical services and support as per NDIS Quality and safe guard commission 2018

• Staff must carry out their duties in accordance with their position description and this code of conduct and as directed by management. • Staff should attend work in a clean and tidy manner, as they are a role model for participants. • Staff has a duty to report any unethical behaviour or wrongdoing by any other staff. • Staff should ensure that resources, funds, facilities or equipment entrusted to them, are used effectively and economically in the course of their duties. • Staff may not use the resources, funds, facilities or equipment for private purposes. Excepting those staff members who have the use organisation equipment as part of their contract of employment. In such cases all conditions relating to their use must be strictly complied with. • Staff should avoid any financial or other interest that could compromise the performance of their duties. • It is the responsibility of the staff member to notify their relevant line manager if a perceived conflict of interest arises. • Staff will respect the rights and privacy of participants in accordance with current standards while recognising their duty of care obligations. • Staff will ensure that co-worker relationships are dignified and respectful. • Staff will not discuss confidential issues of the organisation with people outside the organisation except with agreement of the head of the organisation. • Staff is expected to report participant and staff injuries in the workplace and report any hazards in the workplace that may result in an injury. • Staff will not do anything, which is detrimental to the wellbeing of participants or potential participants of the organisation. • Sexual relationships between staff and participants are not permitted and will be considered potential grounds for instant dismissal and police prosecution. • Staff will represent the organisation in a positive way. • Staff will follow the grievance procedure to try to resolve any conflicts with other staff or members of the organisation. • The organisation will not tolerate harassment in the workplace in any form. Harassment is a discriminatory practice which is unlawful under the Australian Equal Employment Opportunity Act. • The organisation will not tolerate physical or verbal assault, the consumption of alcohol or drugs (apart from prescribed medication) by its staff whilst on duty. • Staff is expected to abide by this code of conduct. Breaches of the code will be dealt with through the staff disciplinary procedure. • Act with respect for individual rights to freedom of expression, self-determination and decision-making in accordance with applicable laws and conventions • Respect the privacy of people with disability • Provide supports and services in a safe and a competent manner, with care and skill. • Act with integrity, honesty and transparency • Promptly take steps to raise and act on concerns about matters that may impact the quality and safety of supports and services provided to people with disability • Take all reasonable steps to prevent and respond to all forms of violence against, and exploitation, neglect and abuse of, people with disability • Take all reasonable steps to prevent and respond to sexual misconduct(Required)

• Staff must carry out their duties in accordance with their position description and this code of conduct and as directed by management.
• Staff should attend work in a clean and tidy manner, as they are a role model for participants.
• Staff has a duty to report any unethical behaviour or wrongdoing by any other staff.
• Staff should ensure that resources, funds, facilities or equipment entrusted to them, are used effectively and economically in the course of their duties.
• Staff may not use the resources, funds, facilities or equipment for private purposes. Excepting those staff members who have the use organisation equipment as part of their contract of employment. In such cases all conditions relating to their use must be strictly complied with.
• Staff should avoid any financial or other interest that could compromise the performance of their duties.
• It is the responsibility of the staff member to notify their relevant line manager if a perceived conflict of interest arises.
• Staff will respect the rights and privacy of participants in accordance with current standards while recognising their duty of care obligations.
• Staff will ensure that co-worker relationships are dignified and respectful.
• Staff will not discuss confidential issues of the organisation with people outside the organisation except with agreement of the head of the organisation.
• Staff is expected to report participant and staff injuries in the workplace and report any hazards in the workplace that may result in an injury.
• Staff will not do anything, which is detrimental to the wellbeing of participants or potential participants of the organisation.
• Sexual relationships between staff and participants are not permitted and will be considered potential grounds for instant dismissal and police prosecution.
• Staff will represent the organisation in a positive way.
• Staff will follow the grievance procedure to try to resolve any conflicts with other staff or members of the organisation.
• The organisation will not tolerate harassment in the workplace in any form. Harassment is a discriminatory practice which is unlawful under the Australian Equal Employment Opportunity Act.
• The organisation will not tolerate physical or verbal assault, the consumption of alcohol or drugs (apart from prescribed medication) by its staff whilst on duty.
• Staff is expected to abide by this code of conduct. Breaches of the code will be dealt with through the staff disciplinary procedure.

• Act with respect for individual rights to freedom of expression, self-determination and
decision-making in accordance with applicable laws and conventions
• Respect the privacy of people with disability
• Provide supports and services in a safe and a competent manner, with care and skill.
• Act with integrity, honesty and transparency
• Promptly take steps to raise and act on concerns about matters that may impact the quality
and safety of supports and services provided to people with disability
• Take all reasonable steps to prevent and respond to all forms of violence against, and
exploitation, neglect and abuse of, people with disability
• Take all reasonable steps to prevent and respond to sexual misconduct

Note: Goodwill Nursing Care holds right to raise a complaint with the NDIS Quality and Safeguards Commission about who breach the NDIS Code of Conduct.

DECLARATION CONFIDENTIALITY

Full Name of Applicant(Required)

First Last

By signing your name here, you agree that this serves as your digital signature, and a physical signature may not be required. You confirm that all the information provided above has been filled out by you and is accurate.

Date(Required)

Comments

This field is for validation purposes and should be left unchanged.

Support Worker Application Form

Pre Employment Collection Form

Criminal History

Resonable Adjustment

PRE-EMPLOYMENT MEDICAL DECLARATION

Privacy

Section 2 – Status of Health

Section 3 – Declaration

APPLICATION FOR EMPLOYMENT

APPLICANTS’ PERSONAL DETAILS:

Bank Account Details

EMERGENCY CONTACT DETAILS:

Employment History

NDIS Code of Conduct

DECLARATION CONFIDENTIALITY

Contact

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