Employment Application Form
Position Applied for:
Application Date:
Where did you find out about this position?
Please indicate that you have read the position description and guidelines:
Yes
No
Personal Information
Title
Mr
Mrs
Miss
Ms
Dr
First Name/s
 Other:
Surname
Address
State
Home Phone
Post Code
Mobile
Email
Are you an Australian citizen or permanent resident?
Yes
No
Yes
No
If you answered no, please specify your VISA type, code and expiry date:
Have you previously worked for On The Line (or Crisis Support Services)?
Availability to Work
Should your application be successful, when could you commence:
Please indicate the days you are AVAILABLE to work:
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Education
Please list any tertiary qualifications that are relevant to this position. We’ll require certified copies of each relevant qualification to be
submitted with the completed Employment Application Form.
Name of Qualification
Educational Institute
Duration of studies (FTE)
Memberships and Registrations
If you have any professional memberships / registrations, please list them here:
Organisation
Membership/Registration Type
Expiry Date
Other qualifications and skills
If you feel you have any other qualifications or areas of expertise that may help in the role you have applied for, please give us a brief
outline here:
Employment Application Form
Version: FM-HRADM-90.1
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Employment Application Form
Professional Referees
Please provide details of 3 referees. Referees must be, or have been, in a direct manager or supervisory role. If that
is not possible from a current employer, please detail in the Comments section below.
Name
Mobile
Title
Office Phone
Email (work)
Organisation
Period of Association
Direct Supervisor/Manager?
Name
Mobile
Title
Office Phone
Yes
No
Yes
No
Yes
No
Email (work)
Organisation
Period of Association
Direct Supervisor/Manager?
Name
Mobile
Title
Office Phone
Email (work)
Organisation
Period of Association
Direct Supervisor/Manager?
Referee Comments:
General Questions
We’d like to know a little more about you and why you are interested in working with us so we kindly ask that you
provide a brief answer to the following questions.
1. Please outline your relevant experience:
2. Why do you want to work with On the Line?
3. What do you hope to gain by working with us?
4. Are you looking for a long-term career – please elaborate on your response:
Employment Application Form
Version: FM-HRADM-90.1
Page 2 of 3
Employment Application Form
Fit and Proper Persons Declaration
Answering yes to any of the following questions does not automatically rule you out of consideration. If
required, we’ll seek further advice to ensure we comply with all relevant laws and legislations.
1. In Australia or overseas have you ever been charged with and found guilty of an
offence or do you have any charges pending against you?
Yes
No
2. Have you ever been refused membership or registration from a registering body in
Australia or overseas?
Yes
No
3. Have you ever had a registration or membership cancelled or suspended (either
partially or fully) by a registering body in Australia or overseas
Yes
No
4. Do you currently have, or ever suffered from, any condition that may impair your
ability to perform in the role you’ve applied for?
Yes
No
If you answered Yes to any of the Fit and Proper Persons questions, you must provide further details below:
Consent to check information
In the event of a successful interview, we will need to check the information you have given us.
Positions that involve client contact will require a national police records check and working with children
check to be done. As those checks require your payment, we’ll ask you to complete them after we have
made an offer of employment however we will require a statutory declaration to be completed in the
meantime.
Please indicate your consent to each of the following questions:
1. I agree to undergo a Police Records Check if required (at my cost)
Yes
No
Current*
2. I agree to undergo a Working with Children Check if required (at my cost)
Yes
No
Current*
3. I agree to undergo a psychometric test if required
Yes
No
4. I consent to On the Line undertaking a professional registrations check
Yes
No
5. I consent to On the Line undertaking reference checks
Yes
No
6. I consent to On the Line collecting and storing information pertaining to my
application
Yes
No
7. I consent to complete a Statutory Declaration as evidence that I have not
committed and been convicted of any crimes if required
Yes
No
*If you have a current Police Records Check or Working with Children Check, please provide a copy with your application.
Please note that only positions with direct client contact will be required to have a working with children check
If you answered No to any of the Consent to check Information questions, please let us know your reasons:
Applicant Declaration
I have read the position description and understand the competencies required to undertake this role. I
understand that any false or misleading information given in this application, whether in writing or during an
interview, may be reason for my employment, if appointed, to be terminated. I declare that to the best of
my knowledge the information provided in this application or in relation to this application, is true, complete
and correct.
Signature/Name:
Date:
Employment Application Form
Version: FM-HRADM-90.1
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