PRIVACY STATEMENT The detail you provide to us will only be used for the purpose for which they were provided that is; any process related to pre-employment, employment and post employment.They will not be used for any other purpose without your consent.The organisation has systems in place to ensure applicant and staff personal and confidential information is safeguarded against loss, unauthorised access, modification or disclosure. Step 1 of 5 20% Have you previously worked for Belvedere Aged Care?*YesNoYes, I have previously worked for Belvedere Aged Care.From*Day12345678910111213141516171819202122232425262728293031Month123456789101112Year20202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920To*Day12345678910111213141516171819202122232425262728293031Month123456789101112Year20202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920What was your position?*No, I have not previously worked for Belvedere Aged Care.Applicant detailsName First Last Address Street Address City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country TelephoneMobileEmail Registration No. (if applicable)Are you a citizen of Australia?*YesNoNo, I am not an Australian citizen.Please state type of residency*Yes, I am an Australian citizen.Please upload copy of passport/birth certificate/citizenship:*Accepted file types: jpg, gif, png, pdf, doc.Driver's licence number*Driver's licence expiry date*Day12345678910111213141516171819202122232425262728293031Month123456789101112Year20202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Have you previously been employed under another name?*YesNoIf yes, please state previous name below: First Last Do you hold a current Police Certificate, issued within the last 3 years?*YesNoYes, I hold a current Police Certificate.Please upload a copy*Accepted file types: jpg, gif, png, pdf, doc.No, I do not hold a current Police Certificate.Have you applied for a Police Certificate to be issued?*YesNoPlease list languages spoken below: Press '+' to enter more than one.Would you be willing to have your language skills assessed and to be used as an interpreter for residents and their families from time to time?*YesNo AvailabilityIf appointed, when can you start?* Monday*AM: 0700 – 1500AM: 0700 – 1300PM: 1500 – 2100PM: 1500 – 2200ND: 2200 – 0700Not available(Hold down 'ctrl' to select more than one option)Tuesday*AM: 0700 – 1500AM: 0700 – 1300PM: 1500 – 2100PM: 1500 – 2200ND: 2200 – 0700Not available(Hold down 'ctrl' to select more than one option)Wednesday*AM: 0700 – 1500AM: 0700 – 1300PM: 1500 – 2100PM: 1500 – 2200ND: 2200 – 0700Not available(Hold down 'ctrl' to select more than one option)Thursday*AM: 0700 – 1500AM: 0700 – 1300PM: 1500 – 2100PM: 1500 – 2200ND: 2200 – 0700Not available(Hold down 'ctrl' to select more than one option)Friday*AM: 0700 – 1500AM: 0700 – 1300PM: 1500 – 2100PM: 1500 – 2200ND: 2200 – 0700Not available(Hold down 'ctrl' to select more than one option)Saturday*AM: 0700 – 1500AM: 0700 – 1300PM: 1500 – 2100PM: 1500 – 2200ND: 2200 – 0700Not available(Hold down 'ctrl' to select more than one option)Sunday*AM: 0700 – 1500AM: 0700 – 1300PM: 1500 – 2100PM: 1500 – 2200ND: 2200 – 0700Not available(Hold down 'ctrl' to select more than one option) Work ExperiencePlease list previous work experience below (max. 5):*PositionEmployerStart DateEnd Date (Press '+' to enter more than one)Current renumeration:RefereesPlease enter at least one referee (max. 5):*NamePosition heldOrganisationContact (Press '+' to enter more than one) Education & MembershipsPlease list education information:*CertificateInstitutionYear completed (Press '+' to enter more than one)Please list details of any present study (if any): (Press '+' to enter more than one)Please list details of any professional association membership (if any): (Press '+' to enter more than one) Medical & Work CoverDo you have any known medical conditions or any pre-existing injuries or diseases of which you are aware of and could reasonably be expected to foresee could be affected by the nature of the position you are applying for?<br>If 'yes', please list below:* If none, type 'no'. If more than one medical condition, press '+' to enter more.Have you previously made a Work Cover claim?*YesNoYes, I have made a Work Cover claim previously.Please provide details below:*Have you ever received a compensation payment because of a common law claim for a work related injury? If yes, please provide details below:*If none, please type 'no'. NOTE: If you fail to disclose information relating to the above, you will not be entitled to Work Cover compensation if the nature of the job aggravates the pre-existing injury or disease. If you have knowingly provided false, misleading, or omit information from this application your employment may be terminated and any Work Cover claim rejected.
