Employment Form

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Section 1: Personal details

First name

Last name

Address

Email address

Telephone number

Residency status

Position applying for

Section 2: Registration and screening

Police Record Check expiry date

VIT expiry date

WWCC expiry date

Section 3: Qualifications

Qualifications Please list any qualifications, the institution and date completed chronological order.

Section 4: Referees

Referee 1 details Provide full name, position, school or organisation, type of reference and contact number for Referee 1.

Referee 2 details Provide full name, position, school or organisation, type of reference and contact number for Referee 2.

Referee 3 details Provide full name, position, school or organisation, type of reference and contact number for an optional third Referee.

Section 5: Applicant's health declaration

Do you have an existing or pre-existing injury, illness or disease that may be affected by the nature of the proposed employment as outlined in the position description? Employment at Shelford Girls’ Grammar (SGG) is conditional on the applicant being a fit and proper person and being able to perform the inherent requirements of the position as described in the position description. This health declaration does enable, where applicable, appropriate and reasonable action to be taken by SGG to meet the provisions of the Workplace Injury Rehabilitation and Compensation Act 2013, the Occupational Health and Safety Act 2004, and obligations under the Equal Opportunity Act 2010. Any recurrence, aggravation, acceleration, exacerbation or deterioration of a pre-existing injury or disease resulting from the employment does not entitle the worker to compensation if you fail to disclose or make a false or misleading disclosure regarding your health.

Yes

No

If yes, please provide details of the injury or condition(s) and what adjustments do you need, to perform the genuine and reasonable requirements of the employment (if any)?

Section 6: Applicant's declaration

I confirm I have read and agreed to the following declaration By checking the box below I certify that the information contained in this application is a true and correct statement of my particulars, qualification, training, experience, competencies and health, and no information concerning my past or present state of health has been withheld. I hereby agree to undergo a health assessment by a medical practitioner if deemed necessary by Shelford Girls’ Grammar. I understand that any willfully incorrect or misleading answer or material omission which relates to any of the questions before mentioned may make me ineligible for employment, or if employed, liable to disciplinary action which may include dismissal. I acknowledge that any non-disclosure or false or misleading information on my part may also result in section 41 of the Workplace Injury Rehabilitation and Compensation Act 2013 (Vic.) being applied which would dis-entitle me from receiving benefits relating to any recurrence, aggravation, acceleration, exacerbation or deterioration of any pre-existing injury or disease which I may have.

Yes

No

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