; TAIHS APPLICATION FOR INCLUSION ON RELIEF WORKER REGISTER
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TAIHS APPLICATION FOR INCLUSION ON RELIEF WORKER REGISTER

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									                                                                                                                       OFFICE USE ONLY:
                                          TAIHS APPLICATION FOR                                                       Board Meeting
                                                                                                                      Acknowledged
                                           INCLUSION ON RELIEF
                                            WORKER REGISTER

Townsville Aboriginal & Islanders Health Services Limited (TAIHS) is an Indigenous community controlled health organisation
committed to improving the physical, emotional & social health and well-being of all Aboriginal & Torres Strait Islander people in
Townsville/Thuringowa & outlying areas. Aboriginal or Torres Strait Islander people are strongly encouraged to apply.


POSITION(S) YOU WISH TO BE CONSIDERED FOR: ..............................................................................................
    Reception/Administration  Mental Health Counsellor                                        Dental Assistant              Driver
    Child Welfare Worker      Residential Care Workers                                        Social Health Counsellor      Cleaner
    Registered Nurse          Health Worker                                                   Stolen Generation Counsellor  Cook
    Other ____________________
AVAILABILITY:
Some positions, such as at the Youth Shelter are required to work outside of normal office hours. This could be up
to midnight and/or into the early morning. Please tell us the times that you are available on each of the days below
(e.g. morning, afternoon, office hours (8:30 am – 5:06 pm) or any time).
 Monday                              Times Available: __________________________
 Tuesday                             Times Available: __________________________
 Wednesday                           Times Available: __________________________
 Thursday                            Times Available: __________________________
 Friday                              Times Available: __________________________
 Saturday                            Times Available: __________________________
 Sunday                              Times Available: __________________________
If casual or temporary contract work becomes available (e.g. up to 3 months), do you wish to be considered?
             Yes  No

PERSONAL DETAILS

NAME: .......................................................................... ......................................................................................
                   Surname                                                                                               Given Names
ADDRESS:..........................................................………. TELEPHONE: (Home) .............................................
............................................................................................                  (Business) .....................................
............................................................................................ P/CODE: .................
EMAIL:                   ...........................................………..
DO YOU CURRENTLY HOLD A DRIVERS LICENCE
      NO  or           YES                      DRIVER’S LICENCE NO: ................................
                                                  LICENCE EXPIRY DATE: ................................
PLEASE TICK TYPE
     CAR (C)
     MOTORCYCLE (RE, R)
     HEAVY VEHICLE/S (MR, HR) .............................................
     LEARNERS
     OTHER ...................................................................
IF YOU ARE APPLYING FOR A POSITION WITHIN TAIHS’S CHILD PROTECTION & ALTERNATIVE CARE
(CPAC) UNIT OR YOUTH SHELTER, YOU WILL REQUIRE A SUITABILITY CARD (BLUE CARD). PLEASE
SEND A COPY OF THE BLUE CARD WHEN YOU SUBMIT THIS APPLICATION. (Please contact TAIHS if you
are uncertain about whether you will require a blue card for the position you are applying for)

Blue card attached?                                NO  or                   YES  Is your card current? (yes or no) ………….


QUALIFICATIONS

PLEASE TICK YOUR HIGHEST ACADEMIC QUALIFICATION COMPLETED:
                         GRADE                     GRADE                     GRADE                     TERTIARY QUALIFICATION
                           1-10                       11                        12                                        
                                                                                                    ........................................…

EMPLOYMENT HISTORY                                 (most recent first and including unpaid/voluntary work)

EMPLOYER (FULL NAME AND ADDRESS): ..........................................................................................

...................................................................................................................................................................

POSITION: .................................................................................... DATES: ...../....../......TO ...../....../.......

DUTIES/SKILLS: ...................................................................................................................................................

.................................................................................................................................................................




EMPLOYER (FULL NAME AND ADDRESS): ..........................................................................................

...................................................................................................................................................................

POSITION: .................................................................................... DATES: ...../....../......TO....../....../......

DUTIES: ....................................................................................................................................................

...................................................................................................................................................................


EMPLOYER (FULL NAME AND ADDRESS): ..........................................................................................

...................................................................................................................................................................

POSITION: .................................................................................... DATES: ...../....../......TO....../....../......

DUTIES: ....................................................................................................................................................

...................................................................................................................................................................


REFEREES
(Name two previous employers who may be contacted or approached for a written or verbal reference)


NAME & ADDRESS: ................................................................................................................................

...................................................................................................................................................................

............................................................................................. OCCUPATION: ...........................................

TELEPHONE: (BUS) ........................(A/H) ......................... PERIOD KNOWN: ......................................
NAME & ADDRESS: ................................................................................................................................

...................................................................................................................................................................

........................................................................................... OCCUPATION: .............................................

TELEPHONE: (BUS) ......................(A/H) ......................... PERIOD KNOWN: ........................................

Are you an Australian or New Zealand citizen?                                            YES                          NO        
If “NO” do you have permanent residency status?   YES                NO 
(Please attach a copy of documentation confirming eligibility to work within Australia)


HEALTH AND SAFETY
Have you any physical, mental, health or emotional condition that should be known to TAIHS in case such
condition may affect your health and safety in particular work situations?                                          YES                      NO 
If YES, Give Details.........................................................................................................................…………………….
...............................................................................................................................................................………………...

There are some positions in TAIHS that are “identified” positions these can only be filled by Aboriginal or
Torres Strait Islander applicants – please complete this section to allow consideration for the most
appropriate employment options.
Do you identify as a member of the Aboriginal or
Torres Strait Islander community?                                                   YES           NO
Are you of Australian South Sea Islander descent?                                   YES           NO
Are you a person from a non-English speaking background?                            YES           NO
Do you need special consideration?                                                                                             YES                      NO
If YES, please give details ............................................................................................................................................
.....................................................................................................................................................................................


What is your current employment status?                                              (please circle)
    Unemployed                                 F/Time Employed                                         P/Time Employed                                         Casual


Do you have a criminal history - including any pending or past charges or convictions that may exclude
your from applying for and/or affect an application for a Suitability ‘Blue Card’ for working with children
and young people?

                                                         YES                                              NO


I declare that my answer is honest and complete………………………………………………                                     /         /
If you are unsure about this question or need information about qualifying for a ‘Blue Card’ please contact the for
Commission for Children and Young People and Child Guardian - www.ccypcg.qld.gov.au or on 1800 113 611
CONDITIONS OF EMPLOYMENT FOR ALL EMPLOYEES
I AGREE TO:
    Comply with the policies and procedures of TAIHS.
    Have and maintain any necessary licence and/or certificates associated with work requirements
     while on the TAIHS relief worker register (e.g. driver’s license, ‘Blue Card’ et.).
    I agree to advise TAIHS of any changes that may affect the status of all mandatory licenses,
     registrations and cards.

I understand that a misleading declaration or omission in answer to any of the questions on this form may
result in my exclusion as a relief worker or if working for TAIHS it may result in disciplinary action and/or
dismissal. I have read and understood the conditions of employment and declare the information to be
true and complete.

APPLICANT’S SIGNATURE: ........................................................................…………….DATE ........./........./.........

 Please send this application to:

                 Human Resource Officer
                 Townsville Aboriginal & Islanders Health Services Limited (TAIHS)
                 PO Box 7534 GBC
                 TOWNSVILLE
                 QLD. 4814
 All application forms must also have attached a current resume; copy of driver’s licence; Suitability ‘Blue
 Card’ and copies all other relevant certifications and registrations required to practice.

   If you do not provide the required documentation you may not be considered for work with TAIHS




Record of Interview – office use only
Interviewed by :                                                                          Date

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