EMPLOYMENT APPLICATION FORM
Mildura Disability Support Services - ABN 61 684 083 574

CONFIDENTIALITY & APPLICATION NOTE

This is a private and confidential application. All information provided will be treated in the strictest confidence and used solely for recruitment purposes.

We understand this application is more detailed than most. That is intentional.

By completing this form, you have already completed around 70 percent of our recruitment process. If your application meets our requirements, you will be offered an interview.

This approach ensures the role is the right fit for you as much as it is for us and avoids wasting your time progressing through a process for a position that may not suit your availability, experience or expectations.

Full Name *

Date of Birth *

Address *

Phone Number *

Email Address *

Are you male or female? *

FemaleMale

Do you have any disabilities or conditions that may affect your employment with Mildura Disability Support? *

YesNo

Please provide details *Details of medical conditions or disabilities

SECTION 1: MANDATORY REQUIREMENTS (NON NEGOTIABLE)

1. NDIS Worker Screening Check status *

Yes, I hold a current checkApplied, waiting for outcomeNo, I do not hold a NDIS Worker Screening Check

NDIS Worker Screening Check Number *

Expiry Date *

Please provide reference number *

2. Working with Children Check status *

Yes, I hold a current checkApplied, waiting for outcomeNo, I do not hold a Working with Children Check

Working with Children Check Number *

Provide Expiry Date *

Provide Application Number *

3. NDIS Worker Orientation Module completed *

YesNoI will complete this

4. Current First Aid and CPR (within 3 years) *

YesNoI will complete this

5. Infection Control Training completed *

YesNoI will complete this

Provide Date Completed *

SECTION 2: TRANSPORT REQUIREMENTS (NON-NEGOTIABLE)

6. Valid Australian driver’s licence *

YesNo

Provide License Number *

Provide Expiry Date *

7. Reliable access to a registered and insured vehicle *

YesNo

8. Have you received any driving fines or infringements in VIC or NSW in the past 5 years? *

YesNo

Please provide details *

SECTION 3: AVAILABILITY ABILITY AND COMMITMENT

Please provide your availability (eg 6-8pm Monday)

Monday *

Tuesday *

Wednesday *

Thursday *

Friday *

Saturday *

Sunday *

How many hours would you ideally like to be rostered on for per week? *

What is your expected hourly rate? *

What is your work type preference? *

SECTION 4: SUITABILITY AND ATTITUDE

Note: The following questions help us understand your suitability for the role, including reliability, flexibility, and experience. Please answer in your own words, as responses that appear AI-generated may be given lower priority.

Do you agree to maintain reliability and flexibility in your role as a Disability Support Worker, including the ability to adapt to changing shifts and client needs? *

YesNo

How did you hear about Mildura Disability Support Services? *

GoogleFacebookWord of MouthOther

Why did you choose to apply for Mildura Disability Support Services? *

What does “empowering independence” mean to you in disability support work, and how would you apply this in your daily practice? *

What strategies would you use when supporting someone with behaviours of concern, and how do you ensure your approach remains calm and person-centred? *

Why have you chosen to work in disability support, and what motivates you to support people living with a disability in their daily lives? *

How would you respond if you identified a risk to a participant’s safety during a shift? Please include the steps you would take. *

Are you trained in or willing to do personal care? *

Yes. I am trained in PC.No. But I am willing to be trained to do PC.No. I am not willing to do PC.

SECTION 5: TECHNOLOGY COMPETENCY

Please briefly describe the systems, apps, or platforms you have experience with.

SECTION 6: EXPERIENCE AND QUALIFICATIONS

What specific experience do you have supporting individuals with disabilities, mental health issues, or aged care needs? *

Do you have any relevant qualifications or lived experience? *

For applicants without direct experience in disability support, please explain why you are interested in this field and what personal qualities or life experience would help you succeed in the role. *

Please upload any relevant certificates or training you have completed *

Browse

SECTION 7: ROLE FLEXIBILITY

Are you willing to work across both disability and aged care support environments as part of your role? *

SECTION 8: REFERENCES

Provide two professional referees (e.g. previous supervisors or managers) with their full names and contact phone numbers. *

SECTION 9: FINAL DETAILS

Start Date: What is your earliest available start date? *

Is there any additional information you would like us to know in support of your application? *

Please upload your resume *

Browse

Consent

I declare that all the information provided in this application is true and correct to the best of my knowledge. I understand that any false or misleading information may result in the termination of my employment. *

Yes I confirm all information provided is true and correctNo, I acknowledge that the information provided may be incomplete or inaccurate

Applicant Signature *

Draw signature|Type signatureClear

Date *