Casual Employment | Providing All Living Supports

Personal Details

Name*

First Middle Last Maiden/Previous Names

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Phone*

Date of Birth*

Email*

Gender*

Male
Female
Other

Hidden

Emergancy Contacts

(Please supply details for 2 emergency contacts. These should be responsible adults who, for example, can assist you to travel if necessary)

Hidden

Name 1

First Last

Hidden

Relationship 1

Hidden

Address 1

Street Address Address Line 2 City State Post Code

Hidden

Phone 1

Hidden

Name 2

First Last

Hidden

Relationship 2

Hidden

Address 2

Street Address Address Line 2 City State Post Code

Hidden

Phone 2

Staff Role

Name of role/position for which you are applying

Availability

Day	Morning 9am – 1pm	Afternoon 1pm – 5pm	Evening 5pm – 7pm	All Day

Do you have any impairment or condition that could be aggravated by doing the tasks listed in the Job Description?

Yes
No

Details

Do you have your own means of transport?*

Yes
No

Do you speak/use other languages?*

Yes
No

Which languages?

Are you willing to undertake training if required?*

Yes
No

Referees

Please nominate two referees e.g. ministers, employers, adult educators (excluding family members)

It is important that you seek permission from your proposed referees before we contact them. Please note that referees will be contacted by PALS Inc

Name 1*

First Last

Phone 1*

Name 2*

First Last

Phone 2

Medical

Are there any health issues/disabilities/courses of treatment or restrictions that may prevent you from performing particular types of activities or that we need to be aware of to provide appropriate support and assistance if required?

Please provide information here

Supporting Documentation

Have you attached the following documentation?

First Aid Certificate
CPR Certificate
Driver’s License
Working With Children’s Check
NDIS Worker Screening Check
Current Qualifications/Resume

First Aid Certificate

Max. file size: 50 MB.

CPR Certificate

Max. file size: 50 MB.

Driver's License

Max. file size: 50 MB.

Working With Childrens Check

Max. file size: 50 MB.

Current Qualifications/Resume

Max. file size: 50 MB.

CAPTCHA

Staff Application Form

Personal Details

Emergancy Contacts

Staff Role

Referees

Medical

Supporting Documentation