First Name (required)
Last Name (required)
Your Email (required)
Phone Number (required)
Street (required)
Suburb (required)
Post Code (required)
Country (required)
State (required)
Are you an Australian Citizen/Permanent Resident? (required) YesNo
If no, do you have a working visa? (Note: to be eligible for employment, applicants must have the appropriate work visa or have permanent residency status) YesNo
Are you of Aboriginal or Torres Strait Islander descent? YesNo
Do you hold an NSW Drivers Licence? (required) YesNo
What class is your licence? (L, P1, P2, C)
Do you have any pre-existing injury or illness of which you are aware that you could reasonably be expected to foresee, could be affected by the nature of the duties and responsibilities of the placement for which you are applying? (required) YesNo
If yes, please provide a brief description. (or on separate advice)
Do you have any convictions, finding of guilt and pending police charges against you that are less than 10 years old? (Note: A satisfactory police record check is a prerequisite of the position) YesNo
If you answered yes to the above, please provide details.
If you have any qualifications, please provide the details of your qualifications (include dates and names of institutions). You will also need to attach certified copies of all qualifications and certificates of attainment.
What is the name of the course you are currently studying?
What is the reason you would like to undertake placement here at Firstcare?
Please indicate the days and times that you are available to complete your placement.
What are the required total hours for your placement?
What is the name of your Education Facility?
Please provide the details of your placement officer (Name, Phone, Email).
Please list three references: including their name, position held, phone number and email, name of the organisation and their relationship to you.
