Main body content information for the online Employment application form for My Place (WA) Pty Ltd website.

Expression of Interest

Welcome to the My Place Electronic Application Form. The form available on this page has been provided for your convenience to be filled out online to assist in the processing of your application.

Employment application form

Personal Details

*Surname:

*First Name:

*Your Address:

*Suburb:

*Postcode:

*Phone 1:

Phone 2:

*Email:

DOB:

Gender:

Male Female

Date/Time:

Where did you hear about My Place

Where:

Do you have?

A current Driver’s Licence (original will need to be cited):

Yes No

Access to a licenced and reliable car?:

Yes No

Would you be willing to use your own car for work purposes if required?:

Yes No

How far would you be willing to travel from home for work?:

Current First Aid Certificate (less than 12 months old):

Yes No

Legally entitled to work in Australia?:

Yes No

Experience

List any relevant experience, qualifications and skills:

Why have you applied for this position?:

Skills

Do you have manual handling skills:

Yes No

If NO, are you willing to learn?:

Yes No

Do you have hoisting skills:

Yes No

If NO, are you willing to learn?:

Yes No

Do you have personal care skills?:

Yes No

If NO, are you willing to learn?:

Yes No

Position sought

Position:

Full-time Part-time Casual

Preferred Hours:

Monday:

Day Evening Night

Tuesday:

Day Evening Night

Wednesday:

Day Evening Night

Thursday:

Day Evening Night

Friday:

Day Evening Night

Saturday:

Day Evening Night

Sunday:

Day Evening Night

Public Holidays:

Day Evening Night

Personal Assistant (home support provided at the consumer’s home):

Co-Resident (home provided by the consumer):

Host Family (support provided in your own home):

Recreation (community-based activities/day support):

Approximately how many hours per week are you available?:

References

Please provide two work references contact details:

Resume

This information has been collected for the sole purpose of assessing the prospective employee’s suitability for vacancies that my arise within My Place from time to time. It will not be shared or sent to any third parties and the information provided will be retained within the system for a maximum of 28 days while your application is considered.