Careers & Staff Employment Application | Companion Care Services Kalgoorlie WA

Step 01 / 13 • Personal Details

Personal Details

Please provide your personal contact information, residential address, and demographics.

Equal Opportunity Employer

We believe in equal opportunity and do not discriminate on the basis of age, race, sex, colour, religion, national origin, disability, or any other applicable status protected by law.

Please ensure that all sections of this employment application are completed accurately.
If successful, our Recruitment Manager will contact you via email and phone to arrange an interview.

First Name *

Surname *

Date of Birth *

Format: DD/MM/YYYY (e.g. 15/04/1992)

Email Address *

Mobile Number *

Residential Street Address *

Suburb *

State *

Post Code *

Country of Residence *

Step 02 / 13 • Vehicle & Superannuation

More About You

Details regarding vehicle access, licence conditions, superannuation, and travel distance availability.

Do you have your own vehicle? *

Is the vehicle comprehensively insured? *

Can you drive with no restrictions? *

Do you have a superannuation account with a registered super company? *

Are you comfortable travelling 20–30 km to visit clients across Kalgoorlie? *

Step 03 / 13 • Emergency Contact

Emergency Contact Details

Please provide contact details for a nominated emergency contact person in case of urgent workplace notification.

First Name *

Last Name *

Relationship *

Email Address

Mobile Number *

Street Address

Suburb

State

Post Code

Step 05 / 13 • Experience & Capabilities

Your Previous Experience

Tell us about your background in support work, health care, or related personal care roles.

Have you previously worked as a Support Worker, Nurse, or Cleaner? *

Previous experience is highly valued, but passionate beginners with the right attitude are also encouraged to apply.

Step 06 / 13 • Safety & Health

Health & Wellbeing

Disability support involves manual tasks, movement, and physical safety. These questions ensure we match you safely to suitable shifts.

Confidential Health Disclosure Companion Care Services maintains strict privacy per the Privacy Act 1988. Information provided will only be used to assess physical suitability and arrange any workplace support or adjustments.

1. Do you smoke? *

2. Do you have any allergies? (e.g. food, pets, latex, medication) *

3. Do you have osteoporosis or bone density conditions? *

4. Do you have an existing physical, medical or psychiatric condition that we may need to take into consideration when scheduling your work? *

5. Do you, or have you ever had a back/neck injury or pain? *

6. Do you have a bad shoulder injury, leg, knee, hip or bulging spinal discs? *

7. Do you, or have you ever had any other injuries or disabilities that we should take into consideration when scheduling you for work? *

Step 07 / 13 • Work History

Employment History

Please provide details of your most recent or relevant employment in healthcare, support work, community services, or customer-facing roles.

Most Recent / Primary Employer

Company or Employer Name *

Position Held *

From Date *

To Date *

Reasons for Leaving *

Step 08 / 13 • Culture & Identity

Diversity & Inclusion

Companion Care Services celebrates cultural and individual diversity. This information helps us promote an inclusive team and match participants with compatible support workers.

Gender *

Do you identify as Aboriginal and / or Torres Strait Islander? *

Are you of a Culturally and / or Linguistically Diverse (CALD) background? *

Is English the main language you speak at home? *

What other languages can you speak?

Do you identify as Lesbian, Gay, Bi-Sexual, Transgender, Intersex and / or Queer (LGBTQI+)? *

Step 09 / 13 • Background Verification 2 must be past employers

Professional References

Please provide contact details for three professional referees who can attest to your work performance, character, and conduct.

1

Reference 1 (Professional / Employer)

Required

Referee Name *

Contact No *

Email Address *

Organisation *

2

Reference 2 (Professional / Employer)

Required

Referee Name *

Contact No *

Email Address *

Organisation *

3

Reference 3 (Professional or Character)

Required

Referee Name *

Contact No *

Email Address *

Organisation *

Step 10 / 13 • Integrity & Compliance

Criminal History & Disclosures

Companion Care Services works with vulnerable individuals. Truthful disclosure is mandatory under the National Disability Insurance Scheme Act 2013.

Statutory Worker Screening Disclosure All disability support workers are subject to mandatory National Police Checks and NDIS Worker Screening. A past record does not automatically disqualify an applicant, but failure to disclose or providing false information will result in immediate rejection or termination.

1. Do you have any convictions, finding of guilt and/or pending police charges against you that are less than 10 years old? *

2. Have you been subject to disciplinary proceedings for misconduct or terminated by an employer? *

3. Have you EVER been convicted of theft, fraud, dangerous driving, drugs, drink driving, assault or aggression to another person? *

4. Are you under Police investigation or have police charges pending for theft, drugs, fraud, poor driving, drink driving or aggravated assault on another person? *

Step 11 / 13 • Roster & Schedule

Weekly Availability Schedule

Please indicate the hours you are available to work each day. If unavailable on a particular day, write N/A or use the quick helper buttons.

Days & Operational Times

Quick fill:

Monday

Start Time

End Time

Tuesday

Start Time

End Time

Wednesday

Start Time

End Time

Thursday

Start Time

End Time

Friday

Start Time

End Time

Saturday

Start Time

End Time

Sunday

Start Time

End Time

Overall, how many hours per week are you IDEALLY wanting to work? *

hrs/week

Casual, part-time and flexible rosters available across all service regions.

Step 12 / 13 • Legal Consent

Applicant's Declaration

Please review each statutory statement carefully and tick each checkbox to confirm your agreement.

1. I declare that all statements which I have made on this Application for Employment are correct to the best of my knowledge and belief, and understand that any misstatement of material facts may affect the success of this or any future employment application with the company. 2. I further understand that failure to provide information or falsely stating any information may result in termination of employment. 3. I further understand and accept that my roster (if applicable) may be changed at any time with due regard to relevant awards and/or enterprise agreement conditions. 4. I also accept that I may be required to undertake a pre-employment medical examination by a Company-appointed GP prior to commencing employment. This pre-employment medical will be based around the inherent requirements of the position/s applied for, and any information will be made available to the Company prior to any offer of employment. 5. I also confirm that I am able to maintain the required standards of fitness, safety, courtesy and neatness at all times and observe all rules and policies of the Company including due care and responsibility of Company property, equipment and monies. 6. I agree to actively participate in random drug and alcohol testing as required. 7. I authorize the hiring company to contact former employers and educational organizations regarding my employment and education. 8. I authorize my former employers and educational organizations to fully and freely communicate information regarding my previous employment, attendance, and grades. 9. I authorize those persons designated as references to fully and freely communicate information regarding my previous employment and education.

Digital Signature Acknowledgment

Full Legal Name of Applicant *

By typing your full legal name above, you certify that you have read, understood, and agreed to all 9 declarations.

Step 13 / 13 • Credentials & Verification

Document Uploads

Please attach your credentials, certifications, and compliance documents below to complete your staff employment application.

Do you have an NDIS Workers Screening Check? *

Required for all NDIS worker clearances across Melbourne, Victoria, and Australia.

Core Identity & Work Documents

Resume / Curriculum Vitae Recommended