Personal Details

Surname

Given Name

Address

Home Telephone

Mobile Phone

Email Address

Proof of Identity

Please attach a copy of your photo identification, for example a Driver’s Licence or a Passport.

Proof of Identity

National Police Check

Have (please provide details)Able to Apply

National Police Number

National Police Expiry Date

Working with Children Clearance

A Working with Children Clearance is a screening process for assessing people who work with or care for children in Victoria. All Staff and Volunteers at Emmanuel College are required to have a Working with Children Clearance .

Have (Please provide details)Able to Apply

Number

Expiry Date

Work History, Skills and Interests

Please list and briefly describe your work history, skills and interests that are relevant to the voluntary role

Work History, Skills and Interests (include 2 referees)

Referees

Please provide the names and contact details of two people who have consented to act as referees and who have been approached to provide verbal references. One of your referees must be a Principal (or equivalent). Please note that the Principal of Emmanuel College reserves the right to contact persons not nominated by the applicant. Applicants will be advised prior to a listed referee being contacted.

Referee 1

Name

Position

Location

Phone

Mobile

Referee 2

Name

Position

Location

Phone

Mobile

Child Safety Disclosure

It is an inherent requirement of the position that you be a person suitable to work in child-connected work. Each of the following questions are relevant to help us understand and determine your likely ability to carry out the inherent requirements of the advertised position. You must answer each question.

1. Have you ever had any disciplinary action taken against you by an employer (e.g. received a warning or had your employment terminated) in relation to any inappropriate or unprofessional conduct? YesNo

2. Have you ever been the subject of an allegation of inappropriate or unprofessional conduct which has been substantiated by an employer or other body? YesNo

3. Have you ever been found guilty of a criminal offence or are you currently facing criminal charges? YesNo

4. Do you consent to the prospective employer contacting the appropriate person at any or all of your current or former employers (including any retired person who at the relevant time may have been employed by a former employer) to confirm the accuracy of your answers in questions 1–3 above and to ask about your suitability to work with children?

If no, this will be discussed further if you are offered an interview

YesNo

I declare that the contents of this form are true and correct.

I understand that any wilfully incorrect or misleading answer or material omission which relates to any of the questions in this form may make me ineligible, or liable to disciplinary action which may include dismissal.

I consent to Emmanuel College making inquiries of any current and/or previous employers in connection to the information and answers I have provided in this form to verify the accuracy of the information in this form and to confirm my ability to carry out the inherent requirements of the position including my suitability to perform child-connected work. I understand and accept that my appointment to this position requires compliance with the school’s child-safe policy and code of conduct. I will read and understand the school’s child-safe policy and code of conduct when available.

Signature

Date

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