Instructions * Before applying please read ‘How to Apply for a Job at STARTTS’ available on our website. * A separate application form must be completed if you are applying for more than one position.WORK EXPERIENCEResume/CV *Choose FileNo file chosenDelete uploaded fileStatement of Essential Requirements (To help us assess your application effectively, please respond to each point on page 2 of the position description clearly and concisely.) *Choose FileNo file chosenDelete uploaded fileCover Letter (Optional)Choose FileNo file chosenDelete uploaded filePOSITION DETAILSPosition Name *Position Number *Where did you see this position advertised? *LinkedInNSW HealthSTARTTS WebsiteIndeedSEEKOtherPERSONAL DETAILSSurnameGiven NamesFemaleMaleX or Non-binaryPrevious Names/AliasesTown & Country of Birth *Telephone (Home)Telephone (Mobile) *Are you currently living in Australia? (Please note that our search is specifically focused on individuals residing in Australia.) *YesNoThank you for your interest! Currently, our opportunities are exclusively for those residing in Australia, and we do not anticipate opening opportunities in other countries. However, we appreciate your understanding and encourage you to stay connected for any other relevant updates.Residential AddressStreet Address *Apartment, suite, etcSuburb *State/Province *ZIP / Postal Code *Country *AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaAustraliaArubaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCabo VerdeCayman IslandsCentral African RepublicChadChileChina, People's Republic ofChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrance, MetropolitanFrench GuianaFrench PolynesiaFrench South TerritoriesGabonGambiaGeorgiaGermanyGuernseyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHeard Island And Mcdonald IslandHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJerseyJohnston IslandJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauNorth MacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontserratMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarReunion IslandRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSaint HelenaSaint Pierre & MiquelonSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and South SandwichSpainSri LankaStateless PersonsSudanSudan, SouthSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwan, Republic of ChinaTajikistanTanzaniaThailandTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks And Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUS Minor Outlying IslandsUnited States of America (USA)UruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis And Futuna IslandsWestern SaharaYemenZambiaZimbabwePostal Address (If different to residential address)Street AddressApartment, suite, etcSuburbState/ProvinceZIP / Postal CodeCountryAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaAustraliaArubaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCabo VerdeCayman IslandsCentral African RepublicChadChileChina, People's Republic ofChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrance, MetropolitanFrench GuianaFrench PolynesiaFrench South TerritoriesGabonGambiaGeorgiaGermanyGuernseyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHeard Island And Mcdonald IslandHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJerseyJohnston IslandJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauNorth MacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontserratMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarReunion IslandRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSaint HelenaSaint Pierre & MiquelonSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and South SandwichSpainSri LankaStateless PersonsSudanSudan, SouthSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwan, Republic of ChinaTajikistanTanzaniaThailandTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks And Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUS Minor Outlying IslandsUnited States of America (USA)UruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis And Futuna IslandsWestern SaharaYemenZambiaZimbabweEmail Address *Do you hold a current NSW Driver’s Licence? *YesNoDriver’s Licence Class: *Are you an Australian Citizen or Permanent Resident? *YesNoIf no, do you hold a current work visa? *YesNoWhat is your visa sub-class? *Visa Restrictions: *YesNo*Restrictions Details below:If you are called for an interview you must provide a copy of your current passport and current visa.VACCINATION REQUIREMENTS for this role. If successful you will need to provide evidence.Category A - Vaccination and/or assessment is required for the following transmissible diseases – measles, mumps, rubella, hepatitis B, varicella (chickenpox), diphtheria, tetanus, pertussis (whooping cough), influenza and tuberculosis. COVID19 vaccination is strongly recommended, but not a requirement for employment. Category B - While it is strongly recommended that employees be vaccinated for COVID-19, influenza, and other transmissible diseases, it is not mandatory to have these vaccinations.CURRENT QUALIFICATIONS - If applicable, please attach copies of your grades.Overseas qualifications: If your qualifications are from overseas, you should have them assessed by a recognized professional in Australia. evaluating, registering and/or licensing body before we can consider them for employment. If you have Certificates/Declarations of Service from any previous employer that are relevant to the job.Choose FileNo file chosenDelete uploaded fileWorking With Children Check (WWCC). If relevant to the role.Working With Children Check Number. OR Application No.:Expire DateOTHER DETAILSLanguages (Optional. If fluency in a language is an essential requirement of the position, please make sure you explain how you meet this requirement in your statement against the selection criteria.)Language 1SpeakWriteLanguage 2SpeakWriteLanguage 3SpeakWriteSPECIAL NEEDS (Optional) If you have any special needs to enable you to attend the interview please list them belowHEALTHTo the best of your knowledge and belief are you in good health?YesNoPlease provide details of any previous or current medical condition or restriction, physical or otherwise, which may affect your ability to perform the essential requirements of the job, and/or any restrictions/requirements which require workplace adjustment.This must include any medical condition or restriction arising from a previous worker’s compensation claim. Failure to provide such information may jeopardise your right to workers’ compensation if a preexisting disability is aggravated at work (Workers’ Compensation Act 1987). Where it is proved that the worker has, at the time of seeking or entering employment in respect of which s/he claims compensation for a disability, wilfully and falsely represented him/herself as not having previously suffered from the disability a dispute resolution body may in its discretion refuse to award compensation which may otherwise be payable.Applicants who have a health condition are invited to discuss its relevance or otherwise to their prospects for employment with the interview panel. A disability or injury is NOT a barrier to the consideration of an application for employment.REFERENCESDo you agree to have referees contacted in relation to this application?YesNo(Reference checks will be conducted in an ethical manner and all information derived will remain confidential) Provide details of three people who can speak on your behalf regarding your work history; as far as possible one referee should be your current supervisor (or immediate past supervisor).Name *Contact NumberEmail Address *Position held/working relationship (e.g. supervisor) *Name *Contact NumberEmail Address *Position held/working relationship (e.g. supervisor) *NameContact NumberEmail AddressPosition held/working relationship (e.g. supervisor)PRIVACY STATEMENTIn accordance with privacy legislation, STARTTS will use the personal information provided by applicants solely for the purpose of making appointments to positions within STARTTS. STARTTS will take all reasonable steps to protect the personal information it collects and uses. It will not disclose such information to any outside organisation. STARTTS will destroy the personal information within 6 months when it is no longer needed for selection purposes, except where the applicant accepts a position within STARTTS. By submitting personal information to STARTTS, applicants are deemed to have given their consent to the collection, use and storage of their personal information for the purpose stated above.DECLARATIONI declare that the above details are correct, including that my qualifications are genuine.I understand and agree that:1. The terms and conditions of my employment will be in accordance with the appropriate Industrial Award or Agreement.2. It is a condition of my employment that I am willing to work at any facilities of STARTTS should this be necessary.3. STARTTS will conduct a ‘Police Record Check’ (CRC) as part of my appointment and if the position is child-related I will provide a ‘Working With Children Check’ (WWCC) clearance or application number.4. STARTTS is permitted to verify my qualifications with the appropriate institution.5. I consent to reference checks which may be necessary to support this application.6. I consent to information on this form and accompanying documents being held bySTARTTS for up to 6 months from date of application if I am unsuccessful. 7. I declare that the statements made by me are true, complete and accurate. I understand that false, misleading or dishonest information provided by me may be grounds for dismissal or non appointment with STARTTS.Date *SUBMITSave as DraftPlease do not fill in this field.