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Support Worker Application Form

1. Personal Details

Residential Address (a PO Box is not acceptable as a residential address)

Postal Address (if different from above)

Contact Details

2. General Employment Information

You will be given the opportunity to discuss information provided before any final decision is made about your selection.

Do you have or have you applied for a Child Related Employment Screening through DCSI with at least six (6) months validity?
Do you have a current Provide or Apply First Aid certificate that was issued within the last three (3) years? Please note, the certificate must be a Provide or Apply First Aid only. * It is a pre-requisite of employment as a Support Worker that you have a Provide First Aid certificate and DCSI Child Related Employment Screening, if you do not have these, this will preclude you from commencing employment.
Are you an Australian citizen or Permanent Resident?
Do you wish to identify yourself as:
Have you ever been employed by HomeCare+ or PQSA?
Do you have any relatives currently employed with HomeCare+ or PQSA?
Are you physically and psychologically able to fulfil the duties of a Support Worker as described in the Position Description? * Medical Clearance will be required under these circumstances.
Do you have any pre-existing illness or injury which may impact on your ability to safely perform the inherent requirements of the position of a Support Worker?

This will not necessarily preclude you from employment but due to Work, Health and Safety restrictions may limit the types of shifts you can attend.

The inherent requirements include (but are not limited to) repetitive actions such as bending, stooping, reaching, twisting and physical work such as Manual Handling of clients.

* Medical Clearance will be required under these circumstances.
Do you speak any other language or have any other skills, which you believe may be useful as a Support Worker? E.g. Sign language.
Do you have a Certificate lll or higher in Disability or Community Services?
Do you have a Certificate III or higher in Aged Care?
Are you currently enrolled and actively studying for a Certificate III or higher in Disability, Aged Care, Community Service or a Bachelor of Nursing?
Have you worked in the Disability sector previously in the last three (3) years?
Have you worked in the Aged Care sector previously in the last three (3) years?
Have you had experience working in a Community setting? i.e. a client's home
Have you had experience working with clients with a Physical Disability, Mental Illness, Neurological or Acquired Brain Injury?
Do you have a current Drivers Licence that enables you to drive in Australia?
Do you have a reliable motor vehicle?
Are you an Agent, Case Worker or other nominee completing this application for the applicant?
Do you have any objection to a HomeCare+ representative seeking verification and additional information on any matter within this application?
I hereby confirm that all my responses to the above questions are true and correct. I understand that any false information, could lead to the termination of my application, or in the future, the termination of my employment.
If successful in the position, you will be required to attend the HomeCare+ inhouse unpaid Pre-Employment training. Will you be willing and available to attend?

3. Education

List your most recent qualification first

Qualification One

Qualification Two

Qualification Three

4. Employment History

Please list your last three(3) most recent positions

Employer One

Employer Two

Employer Three

5. General Position Information

Please indicate what type of support you are willing to provide:

Activities of Daily Living: Showering, toileting, grooming, meal preparation, medication, mobility.
Domestic Cleaning: Dusting, vacuuming, washing, mopping, cleaning bathrooms/toilets, sweeping.
Transport Assistance: Assist with transport, shopping, bill paying, outings.

6. Availability

Please tick the times when you are available to work.
Please be specific in indicating below the times when you are available to work.

0600 -
0900
0900 -
1100
1100 -
1400
1400 -
1700
1700 -
2100
1200 -
0000
Overnight
2230-0700
Monday X X X X X X X
Tuesday X X X X X X X
Wednesday X X X X X X X
Thursday X X X X X X X
Friday X X X X X X X
Saturday X X X X X X X
Sunday X X X X X X X
Are you willing to work flexible hours?
Are you willing to work overnight?
Are you willing to work weekends?
Are you willing to work at short notice?
Are you willing to work 1 hour shifts?
Based on a 1 or 2 hour shift, are you willing to travel 15-30 minutes?

7. Referrees

Nominate three(3) people other than relatives or personal friends.

Referree One

Relationship

Referree Two

Relationship

Referree Three

Relationship

8. Submit Cover Letter and Resume