Employee Application Form – Fair Haven Retirement Village

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FAIR HAVEN EMPLOYMENT APPLICATION:

Url

PERSONAL DETAILS:

First Name *

Middle Name

Surname *

Date of Birth *

Contact Number *

Email Address *

Address *

Suburb *

Postcode

Current Member of the Free Reformed Church of *

POSITION DETAILS:

Position Sought *

Suggested Commencement Date *

Employment Type *

Casual Part Time

Number of Shifts available per week *

EDUCATION DETAILS:

Highest Level of Education/Qualifications *

University Tafe Secondary School

Certificate/Diploma obtained:

Institution Name: *

Year *

Upload copy of Certificate *

Other Education/Qualifications:

EMPLOYMENT HISTORY:

Previously Employed by:

Position Held:

Period of time worked in this position:

Reason for Leaving

Will this be verified by your Manager?

Other Employment/Experience:

REFERENCES:

Name: (Referral 1) *

Contact Number: (Referral 1) *

Written Reference:

Name: (Referral 2) *

Contact Number: (Referral 2) *

Written Reference:

ADDITIONAL INFORMATION REQUESTED:

Do you hold a current Senior First Aid Certificate? *

Yes No

Do you have a National Police Certificate less than 3 months old? *

Yes No

Do you have a Manual Handling Certificate?a National Police Certificate less than 12 months old? *

Yes No

Are you aware of/have any knowledge of pre-existing medical contidion or injury which mich act as an impediment to your performance in this position sought, either now or later in your employment? *

Yes No

Do you agree to a pre-medical appointment by a GP if requested? *

Yes No

PLEASE BE AWARE OF SECTION 79 WORKERS COMPENSATION BOARD AND ASSISTANCE ACT 1981:

79. Where it is proved that the worker has, at the time of seeking or entering employment in respect of which he claims compensation for a disability, will fully and falsely represented himself/herself as not having previously suffered from the disability, the Board may in its discretion refuse to award compensation which otherwise would be payable.

Section 79 acknowledgement:

I acknowledge completely that the deliberate giving of false information, with respect to any of the above areas, shall lead to dismissal.

Upload Resume here:

Declaration:

I hereby declare that the information provided is true and correct. I also understand that any willful dishonesty may render for refusal of this application or immediate termination of employment.

Date:

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Location

Fair Haven Retirement Village
15 Pine Tree Close
ARMADALE WA 6112

(08) 9399 7173
(08) 6496 0379

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