Please complete all sections of this form accurately and legibly. Incomplete applications may not be considered.
First Name
Middle Name
Last Name
Preferred Name
Date of Birth
Street Address
City
State/Province
Postal/Zip Code
Mailing Address (if different)
City
State/Province
Postal/Zip Code
Phone Number
Email Address
Do you have the right to work in [Country]?
If no, please provide details of your visa status.
Driver's License Number
State/Territory
Have you had any driving-related convictions in the last 5 years?
If yes, please provide details.
Company Name
Position Held
Date of Employment From
Date of Employment To
Responsibilities
Reason for Leaving
Contact Name
Phone Number
Company Name
Position Held
Date of Employment From
Date of Employment To
Responsibilities
Reason for Leaving
Contact Name
Phone Number
Company Name
Position Held
Date of Employment From
Date of Employment To
Responsibilities
Reason for Leaving
Contact Name
Phone Number
Highest Level of Education
Relevant Qualifications (e.g., Certificate III in Aged Care, Diploma of Nursing)
Institution
Year Completed
Other Relevant Training (e.g., First Aid, CPR, Manual Handling, Dementia Care, Palliative Care)
Provider
Year Completed
Do you have a current First Aid Certificate?
Do you have a current CPR Certificate?
Do you have a current Police Check/Working with Children Check?
If yes, please provide details
Have you completed any specialized training in dementia care?
If yes, please provide details
Have you completed any specialized training in palliative care?
Responsibilities
Are you familiar with the Aged Care Quality Standards?
Are you familiar with person-centred care principles?
Please describe your experience in providing care to older people, including specific examples of tasks you have performed (e.g., personal care, medication assistance, social support, meal preparation, mobility assistance).
What days are you available to work?
What hours are you available to work?
Are you available to work weekends?
Are you available to work public holidays?
Are you available to work overtime?
Are you available to work on-call?
First Name
Last Name
Phone Number
Email Address
Relationship to you
First Name
Last Name
Phone Number
Email Address
Relationship to you
I declare that the information provided in this application is true and accurate to the best of my knowledge. I understand that providing false or misleading information may result in the termination of my employment if I am successful. I consent to the employer contacting my referees to verify the information provided in this application.
Applicant Signature
Thank you for your application.
Form Template Insight
Please remove this form template insight section before publishing.
This Aged Care Job Application Form is designed to gather comprehensive information about a candidate's suitability for a role in aged care. It's structured to cover key areas that are crucial for employers in this sector. Here's a breakdown of the form and what each section aims to achieve:
Section 1: Personal Details: This section collects basic identifying information about the applicant. It's essential for contacting the applicant and ensuring they are legally able to work in the country. The inclusion of a driver's license question is relevant as some aged care roles may involve transportation of residents or require the staff member to travel between facilities.
Section 2: Employment History: This section explores the applicant's work experience, focusing on their previous roles. It's crucial for understanding the applicant's career progression, responsibilities, and reasons for leaving previous positions. Contacting references is a standard practice to verify the information provided and gain further insights into the applicant's work ethic and performance.
Section 3: Qualifications and Training: This is a very important section for aged care roles. It focuses on the applicant's formal qualifications, specialized training (like dementia care or palliative care), and certifications (First Aid, CPR, Police Check/Working with Children Check). These are often legal requirements or highly desirable for aged care positions. The questions about familiarity with Aged Care Quality Standards and person-centred care principles are key indicators of the applicant's understanding of best practices in the field.
Section 4: Skills and Experience: This is where the applicant gets to showcase their specific skills and experience directly related to aged care. The prompt encourages them to provide detailed examples of tasks they've performed, highlighting their practical abilities and understanding of the needs of older people. This section is crucial for assessing their suitability for the specific demands of the role. The more detail provided here, the better an employer can assess the applicant's fit.
Section 5: Availability: Aged care often involves shift work, weekends, and sometimes on-call responsibilities. This section helps employers understand the applicant's availability and whether it aligns with the needs of the facility.
Section 6: Referees: Providing referees allows employers to gather further information about the applicant's character, skills, and work performance from people who know them professionally.
Section 7: Declaration: This is a standard clause where the applicant confirms the accuracy of the information provided and consents to the employer contacting their referees. It's a legally binding statement.
Key Insights and Considerations for Applicants:
Key Insights for Employers:
This form provides a solid foundation for the hiring process in aged care. By using it effectively, both applicants and employers can make informed decisions.
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