Job Application Disability Support Worker Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Personal InformationName *FirstLastAddressAddress Line 1Address Line 2CityState / Province / RegionPostal Code--- Select country ---AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBolivia (Plurinational State of)Bonaire, Saint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCongo (Democratic Republic of the)Cook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl 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(Republic of)Northern Mariana IslandsNorwayOmanPakistanPalauPalestine (State of)PanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyrian Arab RepublicTaiwan, Republic of ChinaTajikistanTanzania (United Republic of)ThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUgandaUkraineUnited Arab EmiratesUnited Kingdom of Great Britain and Northern IrelandUnited States Minor Outlying IslandsUnited States of AmericaUruguayUzbekistanVanuatuVatican City StateVenezuela (Bolivarian Republic of)VietnamVirgin Islands (British)Virgin Islands (U.S.)Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland IslandsCountryPhone *Email *Upload Your Resume/CV Drag & Drop Files, Choose Files to Upload Upload your resume in .pdf, .doc or .docx formatUpload a Cover Letter Drag & Drop Files, Choose Files to Upload Upload your cover letter in .pdf, .doc or .docx formatWork History Previous Employer EmployerDatesPositionResponsibilities Education HistoryHighest Level of EducationPlease list any relevant certifications or qualifications applicable to the positionCurrent First Aid/CPRYesNoIf yes, upload certification Drag & Drop Files, Choose Files to Upload Skills and QualificationsList relevant skills and qualificationsMedical HistoryDo you have any medical conditions or disabilities that may affect your ability to perform the essential functions of the Disability Support Worker role?YesNoIf yes, provide detailsAre you currently taking any medications that may impact your ability to perform essential duties of the job safely?YesNoIf yes, provide detailsHave you ever been diagnosed with a condition that may require accomodations or modifications in the workplace?YesNoIf yes, provide detailsAvailabilityPlease tell us what hours you are available for work each day of the week.MondayTuesdayWednesdayThursdayFriday active Previous may Are you available for sleepovers?YesNoAre you available for early evening shifts?YesNoAre you available for early morning shifts?YesNoAre you available for active night shifts?YesNoReferencesName *Job TitleCompanyPhoneEmail * Add another Remove Driving RecordLicense TypeList Any RestrictionsSpeeding fine in the past 3 years?YesNoAccidents where you were driving past 3 years?YesNoWere you the driver at fault on any occasion?YesNoAttach Photo of Driver License Drag & Drop Files, Choose Files to Upload Background ChecksPlease provide details of any relevant background checks you have completed or are currently undertaking. These checks may include, but are not limited to, the following:Date of Police Check (Enter Date)Result (Enter Result e.g Clera, Pending etc)Working With Children Check (WWC) NumberDate of WWC CheckNational Disability Insurance Scheme Worker Screening Check (NDISWSC) NumberDate of (NDISWSC) CheckSignaturePlease note that providing accurate and up-to-date information regarding your background checks is essential for consideration for this position. Failure to disclose relevant information may affect your application. I certify that the information provided in this application is accurate and complete to the best of my knowledge.Signature (Initials)Today's DateTerms and Conditions *I agree to the terms and conditions.Submit
