TEACHING SWIMMING for
DECS Sports Swimming & Aquatics Unit
APPLICATION AND GUIDELINES FOR EMPLOYMENT
As a
SWIMMING INSTRUCTOR
and
ASSISTANT SWIMMING INSTRUCTOR
To be completed by applicants seeking employment as instructors with
the Department for Education and Children’s Services
The Package contains 3 sections:
 1. Sport, Swimming & Aquatic Information- please read and keep
for future reference.
 2. Attachments – please read and keep for future reference
 3. Application Form – please complete and return to the Sport,
Swimming & Aquatics Unit.
Sport, Swimming and Aquatics
6th Floor
31 Flinders Street,
Adelaide. S.A. 5001
Tel 08 8226 4137
Fax 08 8232 7021
Website:
www.decs.sa.gov.au/schoolsport
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SECTION 1:
SPORT SWIMMING & AQUATICS INFORMATION
Please read this information and keep it for future
reference.
Do not return it to the Sport, Swimming & Aquatics Unit.
Content:
Are you eligible for employment?
Guidelines for completing the application form.
Employment qualifications for a Swimming Instructor.
What is the process for employment as a DECS Instructor or
Assistant Instructor.
 Permission to teach letter
 Seeking employment
Attachments:
 DECS Preferred providers for First Aid
 List of DECS Centres
 Application Form
2
ARE YOU ELIGIBLE FOR EMPLOYMENT as a Swimming
Instructor and Assistant Swimming Instructor
To be employed by the Sport Swimming & Aquatics Unit you will be
required to comply with the following requirements:
Person Specification
Relationships
The ability to establish and maintain positive and professional working
relationships with children/students, staff and the centre/school community.
Learning Environment
The ability to achieve a productive learning environment by establishing and
maintaining:
 Appropriate centre/pool management strategies
 Appropriate behaviour management strategies
 A safe, supportive, inclusive learning environment.
The ability to provide a swimming lesson using the following:
Curriculum Knowledge
An awareness and understanding of the swimming/aquatics program and its
relationships to student learning.
Programming and Planning
The ability to plan and document a program that is relevant and responsive to
the needs of all children/students in accordance with the Swimming &
Aquatics Development Record.
Assessment and Reporting
The ability to use the Swimming & Aquatics Unit Student Development
Record for assessment, reporting and evaluation processes.
As a SWIMMING INSTRUCTOR you are required to:
Employment declaration
 Be a permanent resident or hold a current permit to work in Australia
 Be a minimum age of 18 years
 Complete a Health Declaration (see Application Form)
Employment qualifications
 Complete an Austswim Swimming Instructor Course
 Complete a Resuscitation Course including a practical examination
provided by a DECS preferred provider
 Complete a First Aid Course provided by a DECS preferred provider
 Complete Asthma First Aid Training
 Complete a full day Mandatory Notification Course
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As an ASSISTANT SWIMMING INSTRUCTOR you are required to:
Employment Declaration:
 Be a permanent resident or hold a current permit to work in Australia
 Be a minimum age of 16 years
 Complete a Health Declaration
 Complete a full day Mandatory Notification Course
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Guidelines for Completing the Application form.
The information required to complete the application form is necessary
to assess eligibility for employment as a Swimming Instructor. This
information is confidential and will be seen only by personnel
processing the application.
1. PERSONAL DETAILS:
DECS Identity number
If you are currently or were previously employed by DECS you will have an
Identity Number. This can be found on your payslip. Please contact the pay
office for assistance if required.
If you are not currently or previously employed by DECS, this section does not
apply to you. You will receive an Identity Number when you receive your first
payslip.
Contact Details:
Please ensure that you contact the Sport, Swimming & Aquatics Unit if there
any changes to your original contact details.
2. APPLICATION TYPE:
Please indicate whether applying as an Instructor or Assistant Instructor.
3. REFEREES
Please nominate the names, titles and contact details for two referees.
4. OTHER INFORMATION
Convictions
Only persons over the age of eighteen (18) years of age are obliged to
complete this section. Have you been charged or convicted of any criminal
offence (including Road Traffic Act offences of a criminal nature)
Please note: you may be required to undergo a police check as part of the
employment process.
Australian Citizen
If you are not a permanent resident or do not hold a current permit to work in
Australia, you are not eligible to be registered as an instructor and therefore
cannot be considered for employment.
Police Checks
Currently no police checks are required for employment as an instructor,
however it will be a requirement in the future. You will be notified of
employment requirements when details are finalised.
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5. TEACHING EXPERIENCE
Registered Teacher
Please complete this section if you are a registered teacher and make sure
you provide the expiry date. The Teaching experience questions refer to
teachers not instructors.
Dismissals/retirements/resignations
Answer questions in this section remembering to state the month and year
where applicable.
6. EMPLOYMENT DECLARATION
In this section you are asked to state that you are/have:
 A permanent resident of Australia
 The minimum age of 18 years for an Instructor and 16yrs for an
assistant instructor.
 Completed the Health Declaration Form.
Health Declaration
Enclosed is a three page Health Declaration that must be completed and
submitted with your application to teach form.
Your application can only be processed when a signed and witnessed health
declaration is provided.
The Health Declaration (ED233) form, must be declared before a Justice of
the Peace in Australia or an approved person under the Oaths Act (1936),
and must be submitted with your application for employment.
Note: A photo copy of the completed form will not be accepted.
If you are intending to submit your Application for Employment to the Sport,
Swimming and Aquatics Unit in person, please make sure that your Health
Declaration has already been declared before a Justice of the Peace. There is
no guarantee that a Justice of the Peace will be available within the Education
Centre.
Information contained in your Health Declaration form remains strictly
confidential and is only accessed for the purpose of ensuring that all
employees are provided with a safe working environment which will not
aggravate any existing medical condition(s). Any information included on the
Health Declaration form is not divulged to centres and schools.
Where appropriate, the Sport, Swimming and Aquatics Unit may request
further information from a medical practitioner. This request will only be in
relation to declarations made on your Health Declaration form and its intent is
to assist DECS in ensuring that all employees are provided with a safe
working environment that will not aggravate any existing medical condition(s).
In accordance with the Occupational Health, Safety and Welfare Act
(1986) section 12, you must notify DECS (Human Resources) of any
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health restrictions you may have and take reasonable care to protect
your health and not aggravate any existing medical condition. It is also
necessary for you to inform the Principal / Instructor in Charge of the
school(s)/centre(s) where you may be employed of any health
restrictions you may have.
7. EMPLOYMENT QUALIFICATIONS FOR SWIMMING INSTRUCTOR
Austswim Instructor Course
The Austswim Teacher of Swimming & Water Safety Certificate is provided by
Austswim S.A.
P.O. Box 321,
Henley Beach, 5022
www.austswim.com.au
There are three components of this course:
 Theory
 Resuscitation
 Practical.
All components of this course must be completed to receive an Austswim
Certificate. This qualification is current for three years and you will be required
to reregister with Austswim every three years.
Candidates who have completed their Practical Component with a DECS
Swimming Program will be given preference in employment.
On completion of the Austswim Course you will be allocated an Austswim
Number which will be used for all future Training & Development and reregistration.
You will be required to provide a Current Austswim Certificate to the Sport,
Swimming & Aquatics Unit every three years to retain your status as an
Instructor.
Resuscitation Course
A Resuscitation Course must be attended and examined annually. The
DECS Preferred Providers List is included.
It is important to note that the Basic First Aid Courses do not automatically
include a CPR Examination, it is therefore necessary to inform the provider
that you require a practical examination and a separate CPR Certificate is
required.
All Senior First Aid Courses automatically include a CPR Examination.
You will be required to provide a copy of the certificate of attendance with
your application to teach.
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Every year you will be required to provide a Current Resuscitation Certificate
to the Sport, Swimming & Aquatics Unit to retain your status as an Instructor.
First Aid
IMPORTANT:
When selecting a First Aid Course first consult the DECS Preferred
Providers List provided in the attachments.
The minimum requirement as an Instructor is to attend a basic first aid
course, eg. BELS (Basic Emergency Life Support), Basic First Aid and Basic
Life Support. However Instructors are encouraged to attend a Senior First Aid
Course. A copy of the Certificate of Attendance must be provided with your
application to teach.
This qualification is current for three years and your updated qualification
must be sent to Swimming & Aquatics Unit every three years to retain your
status as an Instructor.
Asthma First Aid
Asthma First Aid Training must be attended and updated every 3 years. The
courses are available through the following organisations:
 The Asthma Foundation of S.A.- 1 hour course
 Basic Emergency Life Support (BELS) includes the 1 hour asthma
component required – provided by Australian Red Cross, St. Johns
Ambulance and Australian National First Aid Service (ANFAS)
 Royal Life Saving Society Courses and Australian National First Aid
Service (ANFAS) include the 1 hour asthma component – but it must
be noted on the certificate.
Mandatory Notification
A Full day Training in Mandatory Notification is a mandatory requirement for
employment for all applicants. This course outlines the legal requirements for
DECS employees to report child abuse.
For information of session dates and booking of courses contact:
Council of Education Associations of S.A. (CEASA) (08) 8463 5875
Or
Families S.A. 8226 6974 and ask for the Education & Care Focus training.
If this course cannot be completed in time to send with your application
please include a letter of confirmation from one of the above
organisations.
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Employment qualifications for An Assistant Swimming Instructor

Complete a Full Day mandatory Notification Course
No additional qualifications are required to work as an Assistant Instructor,
however the Employment Declaration is required to be completed and
signed by you and witnessed by a J.P.
Please note that the minimum age as an assistant Instructor is 16 years.
Applicants applying for this position are often working towards the position as
an Instructor. It is recommended that complete an application form including
any qualifications that you have, in preparation for the position of Instructor.
When completing your Austswim Course it is advisable that you complete part
of your Practical Component with a DECS Swimming Program.
When seeking employment a candidate with experience in a DECS Swimming
Program will be given preference.
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What is the process for employment as a DECS Swimming Instructor or
Assistant Swimming Instructor
Permission to teach
Once the Sport, Swimming & Aquatics Unit have processed your “Application
for employment” it will be forwarded to the Assistant Director- Staffing for
final approval. This may take up to ten (10) working days to finalise.
Successful applicants will be issued a “Permission to teach” letter which
states:


Type of Appointment i.e. Instructor, Assistant Instructor.
Qualifications and expiry dates.
It is your responsibility to check this information and advise the Sport,
Swimming & Aquatics unit of any discrepancies.
Seeking Employment as a Swimming Instructor.
Once you have received the “Permission to teach” letter it is your
responsibility to contact the schools/centres etc. where you are prepared to
undertake instruction. The Principal or Instructor in charge needs to see your
“Permission to Teach” letter before an offer of employment can be made.
Offers for swimming instruction are made by the appropriate person,
(Instructor in Charge or School Principal) in the centre/school, NOT the Sport,
Swimming and Aquatics Unit.
WE CANNOT GUARANTEE EMPLOYMENT TO APPLICANTS WHO
APPLY FOR EMPLOYMENT AS A SWIMMING INSTRUCTOR.
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Section 2 - Attachments.
 DECS preferred providers for First Aid and
Resuscitation
 List of DECS Centres
Please keep for future reference, do not return to the
Sport, Swimming & Aquatics Unit.
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DECS Preferred providers for First Aid and Resuscitation
Given the increasing number of first aid course providers, DECS has
determined the essential elements that must be covered for a first aid course
to be included on our preferred providers list.
DECS has determined that the following courses cover all the required
contents and should be used when updating your qualifications as your
current qualifications expire:








Australian Red Cross – Basic Emergency Life Support (BELS)
St. Johns – Basic Emergency Life Support (BELS)
Australian National First Aid Services – Basic Emergency Life Support
(BELS)
Royal Life Saving Society – Basic First Aid
State Training Services – Basic Life Support
Ambulance S.A. – Current employees – must provide proof of current
employment.
Surf Life Saving Society – providers of Resuscitation only.
All Senior First Aid Courses offered by the above providers
Upon Expiry of your current qualification you must complete a first aid course
that meets the content requirements.
If you believe another course addresses the elements listed below, the onus
is on you to provide documented evidence this course meets these
requirements.
First Aid Course Content requirements for DECS Employees in the Swimming
& Aquatics Program.








Principles of priorities of first aid
Principles of emergency service access
Resuscitation
Gagging, Choking and Drowning
Asthma
Shock
External Bleeding
Wound Care







Infection Control
Burns and Scalds
Bites and Stings
Allergic reaction
Musculoskeletal injury
Seizures
Hypoglycaemia
CPR Certificate:
Please note that all basic first aid courses listed do not include the
examination of CPR. It is therefore important that, when booking a course,
you advise the provider that a CPR Examination will be required. A certificate
indicating competency in this area must be provided.
Note: All Senior First Aid Course include CPR Examination.
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DECS SWIMMING SITES – contact numbers available from the Sport,
Swimming & Aquatics Unit.
Community Pools
Adelaide AC
Balaklava SC
Balyana Bedford Ind
Barossa Valley Rec
Berri SC
Booborowie Pool
Booleroo Centre CP
Bordertown SC
Burnside SC
Burra SC
Cambrai SP
Clare SC
Coonalpyn SP
Crystal Brook SP
Cummins SP
Darke Peake SP
Elizabeth Aquadome
Eudunda SC
Gawler Pool
Gladstone SC
Hamley Bridge SC
Hawker SP
Jamestown SC
Kapunda SP
Kensington & Norwood SC
Kimba SP
Largs Bay SC
Loxton SC
Magill Campus Pool
Marion SC
Minda Home
Mt Barker Body Heat
Mt Barker Mountain Pool
Mt Gambier AC
Murray Bridge Hydro
Murray Bridge SC
Nangwarry SC
Noarlunga SC
Nuriootpa SC
Orroroo SP
Owen SP
Parafield Gardens SC
Parks Community Centre
Payneham SC
Perfect Fit, McLaren Vale
Penola SC
Pt Augusta ETSA Pool
Pt Lincoln Leisure Centre
Pt Pirie Centre
Quorn SP
Ravelles Health Club
Regency Park Centre
Renmark SC
Riverton SC
Roxby Downs
Salisbury SC
Spalding SP
State Swim-Clovercrest
State Swim-Norwood
Strathalbyn SC
Strathmont SC
Tanunda SC
Tea Tree Gully Waterworld
Thebarton AC
Trengove Indoor Aquatics (Naracoorte)
Unley SC
Waikerie Inland Pool
Waterhole (Mt Gambier)
Whyalla Leisure Centre
Williamstown SP
Woodside SC
Woodville Spastic Centre
Woomera SP
Wudinna SP
(highlighted represent heated
pools)
SCHOOL POOLS
Amata Aboriginal School
Andamooka PS
Angaston PS
Ascot Park PS
Ashford Special School
Belair PS
Black Forest PS
Blanchetown PS
Brighton PS
Brinkworth PS
Brown’s Well District AS
Burnside PS
Cadell PS
Campbelltown PS
Ceduna AS
Christies Beach PS
Cleve AS
Cobdogla PS
Coober Pedy AS
Coomandook AS
Coromandel Valley PS
Cowandilla PS
Cowell AS
Croydon HS
Dernancourt PS
East Murray AS
Davoren Park PS
Forbes PS
Gepps Cross PS
Geranium PS
Hendon PS
Highgate PS
Karcultaby AS
Karoonda AS
Karrendi PS
Kingston on Murray RS
Lucindale AS
Linden Park PS
Lockleys North PS
Loxton North PS
Marree Aboriginal S
Meadows PS
Meningie AS
Mitcham Girls HS
Morgan PS
Murray Bridge PS
Nairne PS
Napperby PS
Northfield PS
Oakbank AS
Oodnadatta Aboriginal S
Parndana AS
Pinnaroo PS
Plympton PS
Pooraka PS
Ramco PS
Renmark North PS
Renmark West P S
Salt Creek RS
Snowtown AS
Swan Reach AS
Tailem Bend PS
Tintinara AS
Urrbrae Ag HS
Victor Harbor PS
West Beach PS
Westbourne Park PS
Wilmington PS
Woodville PS
RIVERS/LAKES/BEACHES
Beachport/Kangaroo Inn AS
Elliston Beach
Glenelg Beach
Kingscote Tidal Pool
Millicent Lake
Moonta Bay
Naracoorte Lake
Penneshaw Beach
Point Sinclair Beach
Point Turton Beach
Port Broughton Beach
Port Elliott Beach
Robe Beach
Stansbury Beach
Tumby Bay Beach
Wallaroo Beach
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Application Form – Swimming Instructor or Asssistant
swimming Instructor.
Before completing this form please make sure that you have
read the information provided in the package:
 Are you eligible for employment?
 Guidelines for completing the application form.
Please return the following details to the
Sport ,Swimming & Aquatics Unit.
6th Floor,
31 Flinders Street,
Adelaide. S.A. 5001
SWIMMING INSTRUCTOR
 Completed Application Form - 3 Pages
 Completed and signed Health Declaration
 Copy of Qualification Certificates
o Austswim Certificate
o Resuscitation Certificate
o First Aid Certificate
o Asthma First Aid Certificate
o Mandatory Notification
ASSISTANT SWIMMING INSTRUCTOR.
 Completed Application Form - 3 Pages
 Completed and signed Health Declaration
 Copy of Certificate for Full Day Mandatory Notification
Course
If you have any of the following qualifications include :
 Copy of Qualification Certificates
o Austswim Certificate
o Resuscitation Certificate
o First Aid Certificate
o Asthma First Aid Certificate
14
APPLICATION FOR EMPLOYMENT AS AN
SWIMMING INSTRUCTOR OR ASSISTANT SWIMMING INSTRUCTOR
PAGE 1
1. Personal Details:
(please use blue or black pen)
Family Name …………………………………………………………………………………..
Given name(s) ………………………………………………………………………………….
Previous Names: ………………………………………………………………………………..
(if applicable)
DECS Identity Number:……………………………
Date of Birth …………………
Residencial Address : Street………………………………………………………………….
Suburb …………………………………………………… Post Code………………………..
Home Phone Number……………………………
Email address ……………………………………
Mobile Phone…………………..
Fax…………………………….
Contact Number (if we are unable to contact you on the home phone no.)
……………………………….
Postal Address: (if same as residential address print ”as above”)
Street…………………………………………………………………………………………………………….
Suburb……………………………………………………………….. Post Code……………………………
2. Application Type:
(please indicate your application type by circling the category applicable)
Swimming Instructor
Assistant Swimming Instructor
3. Referees:
Name…………………………………………. Name………………………………………..
Position Held:………………………………… Position Held ……………………………….
Location ……………………………………… Location …………………………………….
Phone (wk): …………………………………. Phone (wk):…………………………………..
Phone (hm):………………………………….
Phone (hm)………………………………….
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Application Form Page 2
4. Other Information:
Convictions:
Have you ever been convicted of a criminal offence?
Yes / No
(if yes, enclose details in a sealed envelope marked ‘CONFIDENCIAL”)
Are you an Australian Citizen, permanent resident or hold
eligibility to work in Australia?
Yes / No
I understand I may be required to undergo a police check
Yes
5. Teaching Experience:
Are you registered as a teacher in South Australia
yes/no
Expiry Date …………
Total number of years teaching experience:
In DECS
In other school(s) Education Authorities
Dismissals/retirements/resignations
Have you ever been dismissed from a teaching appointment?
If Yes state month and year ……………………
Yes / No
Have you ever resigned from DECS? Yes / No
If yes state month and year ……………………..
Have you ever retired or been invalidated for any employment? Yes / No
If yes state month and year ………………………..
Have you accepted a targeted or voluntary separation package from the
South Australian Government ?
Yes / no
If yes state month and year ………………………….
6. Employment Declaration
I am a permanent resident or hold a current permit to work in Australia.
Yes / No
I am the minimum age of eighteen (18) years for an Instructor.
Yes / No
I am the minimum age of sixteen (16) years for an Assistant Instructor
Yes / No
I have completed the Health Declaration and had it witnessed by a J.P.
Yes / No
Name of applicant…………………………………………………………
Signature of applicant……………………………………..
Date……………………………
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Application
Application Form
Form Page
Page 3
3
7. Employment Qualifications
For Swimming Instructor.
Date
qualification
expires
Tick
indicating
copy of
certificate
attached.
8. Employment Qualifications
Date
For Swimming Assistant Instructor.
qualification
(make sure you have read the employment
expires
requirement details to ensure correct documentation is
supplied)
Tick
indicating
copy of
certificate
attached.
(make sure you have read the employment
requirement details to ensure correct documentation is
supplied)
Austswim Certificate
Resuscitation Course
First Aid Course
Asthma First Aid Course
Mandatory Notification Full Day Course
Or
Mandatory Notification course Confirmation letter
(date of course in expiry date column)
Mandatory Notification Full Day Course
Or
Mandatory Notification course Confirmation letter
(date of course in expiry date column)
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HEALTH DECLARATION
ALL QUESTIONS MUST BE ANSWERED. IF THE ANSWER TO A QUESTION IS YES, FULL DETAILS MUST BE SUPPLIED.
DETAILS REQUIRED INCLUDE THE NATURE OF THE CONDITION, PAST AND/OR PRESENT TREATMENT, AND FULL NAME OF THE DOCTOR
OR SPECIALIST CONSULTED.
IF THE SPACE AVAILABLE IS INSUFFICIENT, PLEASE ATTACH A SEPARATE SHEET.
The information required to complete this form is necessary in order to assess eligibility to qualify for employment as a swimming instructor. This information is confidential
and will only be viewed by personnel involved in processing the application.
Applicants are asked to complete all sections of the Health Declaration form, and submit it with their Application for
Employment as a Instructor/Assistant Instructor or Reactivation Letter along with any supporting or explanatory
material. You can place the Health Declaration in an envelope to maintain confidentiality if you wish.
Do not post the Health Declaration separately. Photocopies will not be accepted.
FULL NAME (MR, MRS, MISS, MS, DR)
...........................................................................................………………………
Address ....................................................... …………………………............................ Postcode ........................
Telephone (Home) ...................................…...
(Business , 9-5 only) ............…………………………...................................
DATE OF BIRTH ..................../................../...............
DECS IDENTITY NUMBER ...........……………...............
I UNDERSTAND THAT IF FURTHER MEDICAL INFORMATION IS REQUIRED I MAY BE ASKED TO GIVE
WRITTEN AUTHORISATION FOR THE DEPARTMENT’S OCCUPATIONAL HEALTH AND SAFETY MANAGER TO
SEEK RELEVANT MEDICAL INFORMATION.
I, ................................................................................................ do declare that the foregoing particulars to the best of
my knowledge are correct, and I make this solemn declaration conscientiously believing the same to be true and by
virtue of the Oaths Act, 1936 as amended.
Declared at: ............................................................................. on ................./.................../............... (Date)
Before me:
(Justice of the Peace)
(signature)
Justice of the Peace:
Number:
(Print Name)
Applicant’s Signature:
........................................................................…………………………………………………………………………………
Full Name:…………………………………………… ……………………………………………………...
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Health Declaration page 2
1.
DO YOU HAVE ANY MEDICAL CONDITION OR RESTRICTION PHYSICAL OR OTHERWISE WHICH MAY
AFFECT YOUR ABILITY TO UNDERTAKE INSTRUCTIONAL DUTIES?
YES
NO
DETAILS .......................................................................................................................................................................................................
…… ...............................................................................................................................................................................................................
......................................................................................................................................................................................................................
......................................................................................................................................................................................................................
2.
DO YOU REQUIRE ANY SPECIAL SERVICES OR FACILITIES TO UNDERTAKE
INSTRUCTIONAL DUTIES?
YES
NO
DETAILS ......................................................................................................................................................................................................
......................................................................................................................................................................................................................
......................................................................................................................................................................................................................
3.
ARE YOU TAKING REGULAR MEDICATION PRESCRIBED BY A MEDICAL PRACTITIONER THAT MAY
AFFECT YOUR ABILITY TO UNDERTAKE INSTRUCTIONAL DUTIES?
YES
NO
If yes, specify medication and reason for usage ............................................................................................................................................
......................................................................................................................................................................................................................
......................................................................................................................................................................................................................
......................................................................................................................................................................................................................
......................................................................................................................................................................................................................
4. HAVE YOU EVER SUFFERED FROM ANY MENTAL OR EMOTIONAL DISORDERS, INCLUDING AN
ANXIETY OR DEPRESSIVE STATE THAT REQUIRE MEDICAL SUPPORT?
YES
NO
DETAILS (include dates) ...............................................................................................................................................................................
......................................................................................................................................................................................................................
......................................................................................................................................................................................................................
......................................................................................................................................................................................................................
......................................................................................................................................................................................................................
5. DO YOU HAVE ANY DIFFICULTIES WITH VISION, VOICE OR HEARING WHICH MAY AFFECT YOUR
ABILITY TO UNDERTAKE INSTRUCTIONAL DUTIES?
YES
NO
DETAILS ......................................................................................................................................................................................................
......................................................................................................................................................................................................................
......................................................................................................................................................................................................................
......................................................................................................................................................................................................................
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Health Declaration Page 3
6.HAVE YOU EVER BEEN REJECTED OR DEFERRED AS MEDICALLY UNFIT FOR SERVICE IN THE
ARMED FORCES, FOR LIFE INSURANCE, FOR PERMANENT APPOINTMENT TO A GOVERNMENT
DEPARTMENT, OR TO PARTICIPATE IN ANY SUPERANNUATION SCHEME?
YES
NO
DETAILS (include dates) ...............................................................................................................................................................................
......................................................................................................................................................................................................................
......................................................................................................................................................................................................................
7.
HAVE YOU HAD ANY SURGICAL OPERATION, A SERIOUS ACCIDENT, OR ANY SERIOUS MEDICAL
CONDITION NOT OTHERWISE MENTIONED THAT MAY AFFECT YOUR ABILITY TO UNDERTAKE
INSTRUCTIONAL DUTIES?
YES
NO
DETAILS (include dates) ...............................................................................................................................................................................
......................................................................................................................................................................................................................
......................................................................................................................................................................................................................
......................................................................................................................................................................................................................
......................................................................................................................................................................................................................
8. HAVE YOU EVER BEEN IN RECEIPT OF WORKERS COMPENSATION?
If yes, please provide details:
Year ..................
YES
NO
State: ...........................
......................................................................................................................................................................................................................
......................................................................................................................................................................................................................
......................................................................................................................................................................................................................
......................................................................................................................................................................................................................
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