Job Application form Job ID Job Title Applicant DetailsTitle*MrMrsMissMsDrFirst Name* Surname* Address* Street Address Address Line 2 City State Post Code Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Contact DetailsWorkHomeMobile*Email* Experience*Qualification/sYear 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 interviewAre 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 examinationDo 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 DetailsAre 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 entitlementsLong Service Leave Entitlement* Yes No Upload your Resumé*Accepted file types: pdf, Max. file size: 128 MB.Please use a PDFUpload your Cover Letter*Accepted file types: pdf, Max. file size: 128 MB.Additional documents Drop files here or Select files Accepted file types: pdf, Max. file size: 8 MB. Please upload pdf files only.CAPTCHA
