Recruitment Form

UNIFORM

When working with Unique living options on a temporary basis, our Professionals are required to wear Uniformed Polo Shirt or Scrubs and ID Badges. We will therefore send through a Polo Shirt or Scrub, a Lanyard and an ID Badge to your home address ideally prior to commencing your first shift with us.

Size of Polo Shirt - Mens

Size of Polo Shirt - Female

Size of Scrubs - Male

Size of Scrubs - Female

Address for Uniform to be sent to:

Unique living options Recruitment has an Equal Opportunities policy which is available upon request. For the sole purpose of monitoring our policy, please indicate your ethnic origin

Where did you hear about us?

If you chose Referral, please confirm who referred you:

EMPLOYMENT REQUIREMENTS

Profession / Job title

Grade / Years of experience

Do you have 6 months or more experience being medication competent?

Yes No

Desired Locations for shifts (areas/suburbs)

Max. travelling time to employment

Can you drive and do you have access to a vehicle?

Yes No

What date are you available to start working shifts

PROFESSIONAL REFERENCES

Please provide details for 3 referees that you have reported to whilst working in the position you are applying for. For example, for an AIN position we accept RN or above and for RN position we accept Supervisor/Manager referees. PLEASE NOTE: The referee must have worked with you in Australia.

Facility where you worked together

Do you have a disability under the terms of the Disabilities Discrimination Act?

Yes No

OVERSEAS CRIMINAL RECORD DECLARATION

Since turning 16, have you been a citizen or permanent resident of a country other than Australia?

Yes No

If Yes, have you ever been convicted of any assault in any other country? *

Yes No

Name of Bank or Building Society

Address of Bank or Building Society

Name of Account Holder

Tax File Number (TFN)

Are you...

An Australian Resident for Tax Purposes A Foreign Resident for Tax Purposes A Working Holiday Maker

Do you want to claim the tax-free threshold from this payer?

Yes No

Do you have a higher education loan program (HELP), student start-up loan (SSL) or trade support loan (TSL) debt?

Yes No

Do you have a financial supplement debt?

Yes No

I request that all my future superannuation contributions be paid to

My Employer’s Superannuation Fund (Australian Super) My Own Choice of Superannuation Fund

Superannuation Fund Name

Superannuation Fund Membership ID Number

COVID-19 DECLARATION

Have you travelled interstate or overseas in the last 14 days?

Yes No

If yes, please provide information.

Have you knowingly been in contact with anyone diagnosed with COVID-19?

Yes No

Do you currently have any of the following symptoms? (Fever; Cough; Fatigue; Shortness of breath; Sore throat)

Yes No

Have you worked at a facility that has had confirmed cases of COVID-19?

Yes No

If so, please provide dates and important information related.

I acknowledge that at any time during my placement, if I develop any symptoms of Coronavirus, or become unwell I will immediately notify my superviser and Unique Living Options and leave the placement environment. *

I have received a copy of the Unique Living Options Recruitment Casual Terms of Employment. I have read and understood those terms and agree to be bound by them. *

I have engaged Unique Living Options Recruitment to act on my behalf to source employment and authorise my resume and details to be presented to their clients.*

I declare that the details given by me on this application form are correct to the best of my knowledge and belief. I understand that if I have given any information which is false, or I withhold any relevant information, this may lead to my application being rejected or if already appointed, to my dismissal. *

I have read and understood the Charter of Aged Care Rights, I understand and acknowledge the importance of these rights when working within Aged Care, Residential Care, Home Care or any other aged care service. I will ensure that I always abide by these rights. Link to the Charter of Aged Care rights if required: https://www.agedcarequality.gov.au/consumers/consumer-rights *

PERSONAL DETAILS

UNIFORM

EMERGENCY CONTACT 1

EQUAL OPPORTUNITIES

SOURCE

EMPLOYMENT REQUIREMENTS

PROFESSIONAL REFERENCES

DISABILITIES

OVERSEAS CRIMINAL RECORD DECLARATION

BANK DETAILS

TAX FILE NUMBER

SUPERANNUATION

COVID-19 DECLARATION

ADDRESS

Contact