Join our team – Aspley Early Childhood Education Centre

Name *

First

Last

Date of Birth *

Sex

Male
Female

Optional

Phone *

Email *

Address

What position are you interested in?

Do you have your own transport?

Yes
No

Are you prepared to work in a smoke free environment?

Yes
No

What type of employment are you seeking?

Full Time
Part Time
Casual

Education: *

TAFE College / University

Qualification(s): *

Certification *

Other Certifications:

Please Specify

Have you ever been charged or convicted of an indictable offence? *

Yes
No

If yes what offence were you charged with or convicted of?

Employment History *

Company Name and type of business

Supervisor Name and Contact Details

Position and Duties

Do we have permission to contact the Supervisor? *

Yes / No

Employment History *

Company Name and type of business

(copy) *

Supervisor Name and Contact Details

(copy) *

Position and Duties

Do we have permission to contact the Supervisor? *

Yes / No

Acknowledgement *

I confirm the information given in this application form is true and factual to the best of my knowledge.
I give permission for Aplsey Early Childhood Education Centre (AECEC) to contact previous places of employment, supervisors and or referees and copying and printing my CV for its own records.
I understand that completing this employment application does not guarantee me employment with AECEC.

Acknowledgement Name *

Name (please print) and Date

Confidential Health Questionnaire - Would any of the following limit your ability to carry out a job? *

Are you allergic to anything that could impact on your ability to carry out work related duties? *

YES / NO (please detail)

Are you receiving or awaiting medical or surgical treatment? *

YES / NO (please detail)

Are you being treated by a doctor for any illness? *

YES / NO (please detail)

Are you taking any regular medications? *

YES / NO (please detail)

Do you agree to comply with our drug and alcohol policy? *

YES / NO (please initial)

Have you ever claimed WorkCover or Workers Compensation for any injury or illness? *

Have you any past / current injuries (eg:back or neck strain, shoulder, wrist) that could be made worse or would impact on you in the workplace? *

Yes / No (please detail)

Do you have past/current condition/sickness that could be made worse or impact on you in the workplace? *

Yes / No nature of illness injury and location.

Do you have past/current condition/sickness that could be made worse or impact on you in the workplace? *

Yes / No nature of illness injury and location.

Declaration *

I am not aware of any health condition which may interfere with my ability to perform the duties of the position of which might lead to any foreseeable injury to myself or others in the normal course of my work.
I am aware any misleading statements may threaten my appointment or continues employment.
I agree to undergo any medical assessments or inoculations as required by AECEC.
I certify the above information to be true and correct to the best of my knowledge.

Declaration Name *

Name (please Print) and Date