Nexus 4 You Support Worker Application

Supportworker Application

Date that you could start work *

Title *

MrsMrMissMsOther

Gender *

FemaleMaleNon-binaryOtherPrefer not to say

Do you identify as Aboriginal/Torres Strait Islander? *

YesNoPrefer not to say

Do you have a Disibailty

YesNo Prefer not to say

First Name *

Last Name *

Preffered Name

Photo of your self *

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Do you require a Visa to work in Australia? *

YESNO

Please provide a copy of your Visa

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Type of Visa *

Arrival Date

Date of Birth *

Emergency contact and relationship to you *

Home Address *

Street *Street address line 2

City *

State *

Postcode *

Country

Do you need to give notice to current employer? *

YESNO

How long is the notice period *

Email Address *

Mobile *

Up load Resume / CV

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Occupational Licenses & Certificates

Compliance Check *

First Aid CertificateCPRDrivers LicensePolice CheckComprehensive Car InsuranceWWVP or WWCC Card New worker NDIS Induction ModuleWorker Orientation ModuleInfection Prevention and Control

Qualifications

Aged Care CertificationDisability CertificationDementia CertificationHome and Community CareSupport CoordinatorAHPRA RegistrationManual HandlingMental Health TrainingMedication Management

Any other information you would like Nexus to know about.

Degree

Trade

Diploma

Certificate

Qualifications

Types of Support Work would like to do

Types of Clients Supports

Personal careSocial activities Community access Domestic assistanceBehaviour management Mental HealthMentoring and peer supportLife skill activitiesMarketing or Job searching activitiesTravel and driving

PRIVACY & PERSONAL INFORMATION CONSENT

Please complete the following consent statement

I hereby declare that the information I have provided in this form is true and accurate and I authorise the company to verify any information if required. Any false or misleading information may result in the termination of my position / application.

I have read and understood my rights in respect of access to and collection of my personal information.

Signed

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