Online Application Expression of Interest 1. ADVERTISED VACANCY Position Title: * Position (Ref) Number: * 2. PERSONAL INFORMATION Title: * Select a Title Mr Ms Mrs Miss Prof Dr First Name: * Last Name: * Preferred Name: Email: * Phone (Primary): * Phone (Secondary): Address: * Suburb: * Country: * AUSTRALIA Other State: * Select State >> WA QLD SA NT NSW TAS ACT VIC State: Post Code: * 3. ELIGIBILITY To be eligible for a permanent appointment at the 91¹ú²ú×ÔÅÄ it is essential that you are an Australian citizen or have permanent residency status in Australia. To be eligible for a fixed term appointment you must have documentary evidence of your entitlement to live and work in Australia for the period of the contract. Are you an Australian Citizen or permanent resident? Yes No Do you have a current working visa? Yes No If you have a working visa: Visa Class: Visa Expiry: September 2024 September 2024 MTWTFSS 352627282930311 362345678 379101112131415 3816171819202122 3923242526272829 4030123456 4. HOW DID YOU HEAR ABOUT THIS POSITION? 91¹ú²ú×ÔÅÄ Website SEEK Newspaper (please specify) Social Networking Site (please specify) Other (please specify) Please specify: 5. REFEREE 1 Please provide details of two referees, ideally a direct line supervisor. Please note that referees will not be contacted without prior consent. Name: * Organisation: * Contact Address: Email: * Phone: * REFEREE 2 Name: * Organisation: * Contact Address: Email: * Phone: * 6. HEALTH To the best of your knowledge and belief do you have a medical condition, disability or injury which may preclude you from undertaking the duties of the position you are applying for? Yes No Applicants who have a health condition, disability or injury are invited to discuss its relevance or otherwise with the panel convenor. It is NOT a barrier to consideration of an application for employment. However, if it is likely to affect your work performance or could recur or be aggravated by the type of work for which you are applying you must disclose this information. 7. WORKERS COMPENSATION Do you have a current or previous Workers Compensation Claim? Yes No If yes, please give details: Workers’ Compensation Claim is NOT a barrier to the consideration of an application for employment. However, any disability or injury likely to affect your work performance or which could recur or be aggravated by the type of work for which you are applying must be disclosed. 8. CONVICTIONS A criminal record does not necessarily disqualify an applicant. However, it is necessary for you to advise whether you have ever been convicted of any offence in any court; or are currently the subject of any charge pending before any court? Yes No If yes, please give details: If rejection of your application is considered solely because of a criminal record, you will be given the opportunity to discuss the matter fully before the final decision is made. You are not required to provide details of convictions declared "Spent" under the ‘Spent Convictions Act’ 1988. NOTE: Offers of employment will be subject to applicants providing a National Police Clearance and appropriate evidence of Australian Citizenship, no later than 14 days prior to their commencement. The 91¹ú²ú×ÔÅÄ reserves the right to withdraw the offer of employment where an applicant possesses a conviction that the 91¹ú²ú×ÔÅÄ considers to be at conflict with their employment. UPLOAD SUPPORTING DOCUMENTS Selection Criteria: Selection Criteria - Only PDF and Word Documents can be uploaded Cover Letter: Cover Letter - Only PDF and Word Documents can be uploaded Resume: Resume - Only PDF and Word Documents can be uploaded Additional Comments Comments: Type the code from the image: Get Audio CodeType the code from the image Declaration I declare the above statements to be true in all respects. I acknowledge that any statement which is found to be false or deliberately misleading will make me, if employed, liable for dismissal. I agree *