Disability Support Worker Application Package

1/8

Information

Personal Details

Upload Profile:

First Name:

Middle Name:

Last Name:

Date of Birth:

Country of Birth:

Address:

Suburb:

Postcode:

Home Phone:

Mobile:

Email:

Gender:

MaleFemaleNon-Binary/Other

Languages:

QUALIFICATION

CERT III QUALIFICATIONS OR HIGHER

DISABILITY STUDIES

Date Attained:

Aged Care

Date Attained:

WELFARE

Date Attained:

OTHER

Date Attained:

Other Qualifications:

14%

CLEARANCES:

WWCC

Yes

Date Attained:

Upload Certificate:

POLICE CHECK

Yes

Date Attained:

Upload Certificate:

FIRST AID

Yes

Date Attained:

Upload Certificate:

28%

Vehicle/Licence:

C Class Driver’s License:

YesNo

Automatic
Manual

Licence Number:

State of issue:

Expire Date:

Care Make:

Car Model:

Car Age:

Car registration Number:

Registration Renewal:

Review Date: March 2022

42%

AVAILABILITY:

Work Preference:

Permanent Full timePermanent Part timeCasual

What days and Time are you available over the week, please select the Sessions Below?

Time Available:

Date Available:

Review Date: March 2022

71%

REFEREES

Employer:

Supervisor:

Phone Number:

Address:

Employer:

Supervisor:

Phone Number:

Address:

EMERGENCY CONTACT

Name:

Contact:

Relationship:

Name:

Contact:

Relationship:

85%

DECLARATION

I declare that all information provided in this application is true in all respects.

I understand that any misrepresentation of facts in this application could be cause for termination, if
employed.

I consent to any reference checks, which may be necessary to support this application.

I understand that employment with Asayish Comfort Care is conditional upon production of evidence
regarding:

• Australian Citizenship or Permanent Residency or Visa/Work Permit status;
• Satisfactory (current) Police Certificate and Traffic Convictions Certificate;
• Current valid driving license;
• Current First Aid Certificate
• Working with Children Certificate (if applicable)
• NDIS Worker screening Check, NDIS Induction and COVID 19 – Training Certificates

I acknowledge and agree with the declaration as stated above

Employee Name:

Signature:

Date:

Supervisor Name:

Signature:

Date:

Review Date: March 2022

100%

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