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EMPLOYMENT EXPRESSION OF INTEREST

Occupational Therapist

Date

First Name

Surname

Are you an Australian citizen or resident?

YESNO

Are you a qualified Occupational Therapist?

YesNoNo but will be soon

Email Address

Mobile

Home Address

Home Ph

Suburb

State

Postcode

WORK AVAILABILITY / PREFERENCE

I can start work by (eg 9am)

I need to finish work by (eg 4pm)

Work type

CasualPart-timeFull-timeAny of the above

Maximum hours per week

INCOME EXPECTATIONS

What are your income expectations?

Hourly Rate

Annual Salary

DETAILS OF EMPLOYMENT

**Please provide details below ( at least the last three positions held )

Position #1

START DATE OF EMPLOYMENT

FINISH DATE OF EMPLOYMENT

COMPANY

POSITION HELD

REASON FOR LEAVING

Position #2

START DATE OF EMPLOYMENT

FINISH DATE OF EMPLOYMENT

COMPANY

POSITION HELD

REASON FOR LEAVING

Position #3

START DATE OF EMPLOYMENT

FINISH DATE OF EMPLOYMENT

COMPANY

POSITION HELD

REASON FOR LEAVING

Position #4

START DATE OF EMPLOYMENT

FINISH DATE OF EMPLOYMENT

COMPANY

POSITION HELD

REASON FOR LEAVING

Position #5

START DATE OF EMPLOYMENT

FINISH DATE OF EMPLOYMENT

COMPANY

POSITION HELD

REASON FOR LEAVING

Do you need to give notice to current employer?

YESNO

How Long?

Do you have any upcoming commitments/pre-booked holidays?

YESNO

Give Details

Do you have a 2nd Employer / Job?

YESNO

Give Details

Are you going for other roles elsewhere?

YESNO

Give Details

Are you registered with other recruitment agencies?

YESNO

Give Details

REFEREES / REFERENCE NOMINEES

** WORK references ONLY (not family members or friends)

Must supply MINIMUM OF TWO names and companies who could speak on your behalf

Referee #1

Company

Person to contact

Title

Business Phone No.

How long have you known Referee #1?

Referee #2

Company

Person to contact

Title

Business Phone No.

How long have you known Referee #2?

Referee #3

Company

Person to contact

Title

Business Phone No.

How long have you known Referee #3?

Occupational Licences & Certificates

Please indicate your licences/training (please provide copy/s with your application)

First Aid

First Aid - Basic

Please upload First Aid - Basic Certificate

Browse

First Aid - Senior

Please upload First Aid - Senior Certificate

Browse

Perform CPR

Please upload Perform CPR Certificate

Browse

Drivers Licence

C' Class

Please upload C' Class Licence

Browse

Qualifications/resume

** Please advise your qualifications and provide certificates where possible**

Details of qualifications:

Copy of qualifications /resume

Browse

Health and Safety / Medical Questionnarie

Please answer the following questions and provide details where applicable.

Have you ever had any injuries that impacted on your ability to perform work?

YESNO

Details

Do you have medical condition or disability:

YESNO

Details

Signed

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WORK AVAILABILITY / PREFERENCE

INCOME EXPECTATIONS

DETAILS OF EMPLOYMENT

REFEREES / REFERENCE NOMINEES

Occupational Licences & Certificates

Health and Safety / Medical Questionnarie

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