WORKING AT PALS Staff Application Form Personal DetailsName* First Middle Last Maiden/Previous Names Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Phone*Date of Birth* DD slash MM slash YYYY Email* Gender* Male Female Other HiddenEmergancy Contacts(Please supply details for 2 emergency contacts. These should be responsible adults who, for example, can assist you to travel if necessary)HiddenName 1 First Last HiddenRelationship 1 HiddenAddress 1 Street Address Address Line 2 City State Post Code HiddenPhone 1HiddenName 2 First Last HiddenRelationship 2 HiddenAddress 2 Street Address Address Line 2 City State Post Code HiddenPhone 2Staff RoleName of role/position for which you are applying AvailabilityDayMorning 9am - 1pmAfternoon 1pm - 5pmEvening 5pm - 7pmAll 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 RefereesPlease 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 IncName 1* First Last Phone 1*Name 2* First Last Phone 2MedicalAre 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 hereSupporting DocumentationHave 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 CertificateMax. file size: 50 MB.CPR CertificateMax. file size: 50 MB.Driver's LicenseMax. file size: 50 MB.Working With Childrens CheckMax. file size: 50 MB.Current Qualifications/ResumeMax. file size: 50 MB.CAPTCHA
