Please answer the following questions

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					          All information received will be handled and used in accordance with our obligations under the Privacy Act 1988
Applying for the
position of

Given Names

Preferred Name

Date of Birth



State                                                                                       Postcode

Home Phone                                                                                  Mobile Phone

Email Address

Use email to send payslips?                                                  Yes     No

Next Of Kin                                                                                 Phone No

Please answer the following questions:

1. Do you have a current ( less than 3 years old) Federal Police Record Check?                                   Yes    No
   If yes please enclose.
2. Do you identify as Aboriginal and/or Torres Straight Islander?                                                Yes    No
3. Do you have a culturally and linguistically diverse background?                                               Yes    No

    If so please identify nationality
4. Are you physically able to undertake all the tasks ( as outlined in the Position Description)                 Yes    No
   that this position requires?
5. Confirmation of employment including duties performed in your current employment, must
  be obtained prior to any employment offer being made. Do you agree for your current
  employer to be contacted as part of the reference checking process?                                            Yes    No

I have read the position description for the positon I am applying for and to the best of my knowledge. I belive that
the information supplied in this application is true and correct. I understand that any deliberately false, misleading
or incomplete statements may lead to my dismissal, if employed. Further I acknowledge that if successful in my
application I will be required to complete a probity process that will include a federal police record check.
  Signature                                                                         Dated

integratedliving Australia Limited, PO BOX 637, Muswellbrook NSW 2333. Phone 1300 364 584

FOR OFFICE USE ONLY                      Date Received                          Initial
                                                              Version 8
Qualifications and Skills: (Can be attached)

Employment History, commencing with your current or most recent employer.

     Dates (from / to)          Position Held          Employer Name & Address         Contact & Telephone Office Use Only

Referees Contact Details ( Referees must be employment related)
                         Name                                                Address                       Phone Number


                                                Print Form                 Submit by Email

integratedliving Australia Limited, PO BOX 637, Muswellbrook NSW 2333. Phone 1300 364 584
                                                               Version 8

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Description: Please answer the following questions