DSW - Casual - Job Application Form

Casual Job Application Form

Please complete and check all sections before submission
About You
Name*

First NameLast Name
Mobile phone number*
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState

Post Code
Date of birth*

DayMonthYear
Date of birth
Gender*
Are you fully vaccinated against Covid-19 (2 vaccination shots)*

YesNo
Do you have any health conditions that would impact your ability to support someone in achieving daily living activities?*

YesNo
Details of health condition(s)*
Have you claimed workers’ compensation for the above?*

YesNo
Do you have medical clearance to undertake the specific tasks required for this role?*

YesNo
Please note: We may ask you to provide a copy of your medical clearance
Do you speak any languages other than English?*

YesNo
Other languages spoken*
Residency Status*

Australian CitizenPermanent ResidentWorking Visa
Please Note: CCA will undertake a verification of your work rights through VEVO.
Visa Work Eligibility*

YesNo
Type of Visa*
Sorry! You must be eligible to work to be employed by CCA, Please check the Work Eligibility of your Visa.
Visa expiry date*

DayMonthYear
Date
Visa number*
Probity Checks
Have you completed NDIS Worker Screening Clearance (NDISWC)?*

YesNo
Have you obtained a current copy of a Working with Children Check (WWCC)?*

YesNo
Have you obtained a Police record check in the last 2 years?*

YesNo
Please Note: If your application for employment with CCA is successful you will be required to undertake NDIS Worker Screening Clearance.
Please Note: If your application for employment with CCA is successful you may be required to obtain a WWCC.
License Information
Do you hold a current driver’s licence?*

YesNo
License type*
Do you own a registered car?*

YesNo
Do you have comprehensive insurance?*

YesNo
Your Availability
Available Saturday*

YesNo, Not available Saturdays
Available Sunday*

YesNo, Not available Sundays
Available Monday*

YesNo, Not available Mondays
Available Tuesday*

YesNo, Not available Tuesdays
Available Wednesday*

YesNo, Not available Wednesday
Available Thursday*

YesNo, Not available Thursdays
Available Friday*

YesNo, Not available Fridays
Saturday Availability*
(e.g. 9am - 11am, 3pm - 8pm or ALL DAY for 6am to 10pm)
Available for Saturday Sleepover (10pm - 6am)*

YesNo
Sunday Availability*
(e.g. 9am - 11am, 3pm - 8pm or ALL DAY for 6am to 10pm)
Available for Sunday Sleepover (10pm - 6am)*

YesNo
Monday Availability*
(e.g. 9am - 11am, 3pm - 8pm or ALL DAY for 6am to 10pm)
Available for Monday Sleepover (10pm - 6am)*

YesNo
Tuesday Availability*
(e.g. 9am - 11am, 3pm - 8pm or ALL DAY for 6am to 10pm)
Available for Tuesday Sleepover (10pm - 6am)*

YesNo
Wednesday Availability*
(e.g. 9am - 11am, 3pm - 8pm or ALL DAY for 6am to 10pm)
Available for Wednesday Sleepover (10pm - 6am)*

YesNo
Thursday Availability*
(e.g. 9am - 11am, 3pm - 8pm or ALL DAY for 6am to 10pm)
Available for Thursday Sleepover (10pm - 6am)*

YesNo
Friday Availability*
(e.g. 9am - 11am, 3pm - 8pm or ALL DAY for 6am to 10pm)
Available for Friday Sleepover (10pm - 6am)*

YesNo
Please provide details of any commitments that may impact on your availability (e.g. family, other job, study)
Professional References
1. Reference Name*

First NameLast Name
1. Organisation*
1. Relationship to You *
(e.g. Manager, Supervisor etc)
1. Daytime Contact No*
1. Email Address*
example@example.com
1. Period of Employment: From *

DayMonthYear
Date
1. Period of Employment: To*

DayMonthYear
Date
2. Reference Name*

First NameLast Name
2. Organisation*
2. Relationship to You *
(e.g. Manager, Supervisor etc)
2. Daytime Contact No*
2. Email Address*
example@example.com
2. Period of Employment: From *

DayMonthYear
Date
2. Period of Employment: To*

DayMonthYear
Date
DECLARATION

I understand the information I provide in my application will be destroyed after 3 months if I am not successful in my application.

I certify that the information I have provided on my application, is to the best of my knowledge true and accurate. I understand that Community Connections Australia (CCA) has the right to verify all information I have provided. Any statement that is found to be deliberately misleading or false may lead to rejection of my application or my dismissal if employed.
Signature*

Clear
Date

DayMonthYear
Date
Should be Empty:

Casual Job Application Form