Job Application Form

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Applicant Details

Title*

First Name*

Surname*

Address*

Street Address Address Line 2 City State Post Code Country

Contact Details

Work

Home

Mobile*

Email*

Experience*

Qualification/s	Year Qualification/s Obtained

Are you an Australian Citizen / Permanent Resident?*

Yes
No

Do you have a current working visa?*

Yes
No

ORIGINAL work visa or permanent residency status must be presented at interview

Are you of Aboriginal or Torres Strait Islander descent?*

Yes
No

Do You have a current National Police check?

Yes
No

Do you hold a current Australian Drivers Licence?*

Yes
No

Do you require any special arrangements at an interview?*

Yes
No

Have you had a flu vaccination this year?*

Yes
No

Please provide details*

Are you aware of any pre-existing injury or disease that you could reasonably be expected to foresee, that could be affected by the nature of the duties and responsibilities of the position for which you are applying?*

Yes
No

Please provide a brief description (or on a separate advice)*

(Note: failure to disclose or making a false or misleading disclosure may impact on your right to compensation under the Workplace Injury Rehabilitation and Compensation Act 2013) YDHS may request a pre-employment medical examination

Do you have any convictions, finding of guilt and/or pending police charges against you that are less than 10 years old?*

Yes
No

You must provide a National Police Record Check prior to commencing work. This must be 3 years or less from date of issue.

Please provide brief detail*

Employment Details

Are you an existing staff member?*

Yes
No

Position Ttitle*

Area*

Are you currently employed?*

Yes
No

How long have you been with this employer?*

How many hours per week do you work?*

Is your current employer in the Health Services Industry?*

Yes
No

If yes, you may be entitled to transfer entitlements

Long Service Leave Entitlement*

Yes
No

Upload your Resumé*

Accepted file types: pdf, Max. file size: 128 MB.

Please use a PDF

Upload your Cover Letter*

Accepted file types: pdf, Max. file size: 128 MB.

Additional documents

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Accepted file types: pdf, Max. file size: 8 MB.

Use a PDF

Applicant Details

Contact Details

Employment Details

Crossley House Hostel

St Elmo’s Nursing Home

Yarram and District Health Service

Urgent Care Entrance

Edgar House

Acute

Funding Acknowledgement

Acknowledgement