Application for Employment Form WA

My Supports Application for Employment Form

Western Australia Applicants
Part 1: Applicant Details
Name

First NameLast Name
Date of Birth
Gender
E-mail
Mobile Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Smoking Status

SmokerNon-Smoker
How did you hear about My Supports?

Search Engine (Google, Yahoo, etc.)Social MediaPrinted AdvertisementWord of MouthOther
Team Applying (Your Local Government Area)
Role Applying
If you have selected Indeed Advertisement, please write the Job Title below:
I have a current Motor Vehicle License and Vehicle

YesNo
Do you have any special drivers licence conditions or medical conditions that may effect your driving?
Part 2: About Me
Tags

Tags help us best match our support workers with our clients based on cultural background, skills, hobbies and qualifications.
Please tick the boxes that are relevant to you

Aboriginal & Torres Strait IslanderAdvocacyArt and CraftsCertificate in Aged CareCertificate in DisabilityEducation BehavioursExperience with Challenging BehavioursCleaningComputersFirst Aid CertificateGardeningHandy WorkHost FamilyManual Handling SkillsMusicPEG TrainedPhotographySportsTherapist (Qualified)CALD Background (Culturally and Linguistically Diverse)
If you Ticked CALD, please let us know your Cultural Background
Availability
Please tick the days you are available to work. If you need to let us know about specific times etc. use the notes box below.

Monday AMMonday PMTuesday AMTuesday PMWednesday AMWednesday PMThursday AMThursday PMFriday AMFriday PMSaturday AMSaturday PMSunday AMSunday PM
Please let us know what days and times you would be available to work.
Notes
Qualifications and Work Experience in Disability

Please note: Evidence of qualifications will need to be presented during your interview.
I have worked as a Disability Support Worker

YesNo
I have qualifications or certificates related to working with Disability

YesNo
If yes, please provide details
I have experience in Advocacy and representing the rights of people with a disability.

YesNo
If yes, please provide details.
Checks and Clearances

If you do not currently have the following checks and clearances you will need to obtain them if you are offered a position with My Supports.
NDIS Worker Screening Check

YesNo
If Yes, Please provide your Screening Number
Screening Number should be 8 digits Long
Working with Children Check

YesNo
NDIS "Quality, Safety and You" Orientation Module Certificate

YesNo
First Aid Certificate

YesNo
Manual Handling Skills (this is not a requirement)

YesNo
Please Provide Three Referees
Referee 1 Name
Company Name
Contact Number
Contact Email
Referee 2 Name
Company Name
Contact Number
Contact Email
Referee 3 Name
Company Name
Contact Number
Contact Email
I authorise and consent to My Supports contacting my previous employers and referees at any stage of the recruitment process. I recognise that reference checks do not mean I am guaranteed a position with My Supports.

YesNo
Part 3: Values
I have lived experience of disability, as a family carer or friend or I am a person with a disability.

YesNo
If yes, please describe
What Values and skills could you bring to My Supports?
What do you feel is the most important role of a Support Worker or Team Leader?
Part 4: Legal Information
Offences, charges and related matters.

As an NDIS provider, we are committed to ensuring the safety and wellbeing of the people we support. To meet our obligations, we assess all candidates’ suitability for employment, including reviewing any relevant history.Disclosing a record does not automatically preclude you from being employed. However, we may seek further clarification and ask additional questions to undertake an appropriate risk assessment. Your responses will be handled confidentially and considered in line with the inherent requirements of the role.
Have you ever been charged or convicted of any offence?

YesNo
If yes, please supply details
Have you received any charges or convictions related to driving offences?

YesNo
If yes, please supply details
Have you ever resigned or been dismissed from a position because of allegation of theft, dishonesty or unacceptable work practice?

YesNo
If yes, please supply details
Have you ever been the subject of a disciplinary proceedings by your employer or a governing regulatory authority e.g. Work Safe (or equivalent)

YesNo
If yes, please supply details
Medical Information

Section 79 of the Workers compensation and Injury Management Act sets out the following:
Willful and false representation: "where it is provided that the worker has, at the time of seeking or entering employment in respect of which he claims compensation for an injury, willfully and falsely represented himself as not having previously suffered from the injury an arbitrator may in the arbitators discretion refuse to award compensation which otherise would be payable"
Have you ever made a Workers Compensation Claim?

YesNo
If yes, please supply details
Have you ever injured yourself at work, or received, or are currently receiving payment in relation to any illness or injury suffered by you?

YesNo
If yes, please supply details
Are you currently receiving medical treatment for any condition, or taking medication which could affect your work in the position applied for?

YesNo
If yes, please supply details
Part 5: Attached Documents

For your application to be processed you must attach the following documentation;
Resume *

Upload a File

Cancelof
Current Drivers License or other valid ID

Upload a File

Cancelof
Working with Children Check

Upload a File

Cancelof
Any Other Files to Help Support Your Application

Browse Files
e.g. Proof of Right to Work in Australia, Relevant Qualifications or NDIS Worker Screening Certificate Cancelof
Please note if your application is successful you will need to obtain the following certification:
- NDIS Worker Screening Check
- Working with Children Check (if working with children)
Part 6: Declaration
e

Yes
Applicant Signature
Date Completed

MonthDayYear
If your Application is successful you will be notified by phone and will be required to attend an interview.
Should be Empty:

My Supports Application for Employment Form

Part 1: Applicant Details

Part 2: About Me

Tags

Availability

Qualifications and Work Experience in Disability

Checks and Clearances

Please Provide Three Referees

Part 3: Values

Part 4: Legal Information

Offences, charges and related matters.

Medical Information

Part 5: Attached Documents

Part 6: Declaration