Application for Employment form | NCN Health Careers

PERSONAL DETAILS*
Surname: Given Names:
Current Residential Address*
Street Address: Address Line 2 City State ZIP Postcode
Postal Address:
Street Address: Town State Postcode
Email Adress:*
Mobile Number*
Phone Number*
Are you Aboriginal or Torres Strait Islander?*
- Yes
- No
- Prefer Not To Say
Date of Birth:*
Date Format: DD slash MM slash YYYY
Country of Birth*
ELIGIBILITY TO WORK IN AUSTRALIA Please tick the relevant Australian Citizenship*
Please tick the relevant Australian Citizenship or Residency Status and provide the required documentation.
- Australian Citizen (If born in Australia, please attach copy of Birth Certificate and/or Australian Passport. If born Overseas, please attach copy of Australian Citizenship Certificate and/or Australian Passport)
- Permanent Resident
- Application in Progress
- Other Visa with Work Entitlements
File
Drop files here or
OTHER DETAILS:
Do you have a Police Check dated within the last 6 months?*
Do you have a Police Check dated within the last 6 months? If yes, please attach copy (Regulations state that all employees must have a current police certificate. NCN Health are able to conduct Police Checks which can only be used by this Health Service, alternatively employees can source their own Police Check which a copy will need to be provided, these are at the expense of the employee.)
- Yes
- No
File
Have you been convicted of an offence of any nature? If yes, please attach to this document details of each offence including dates.*
Have you been convicted of an offence of any nature? If yes, please attach to this document details of each offence including dates.
- Yes
- No
File
Do you have a current Working With Children Check as employee (WWCC)?*
Do you have a current Working With Children Check as employee (WWCC)? If yes, please attach copy All employees are required to hold a current WWCC, this will be at the expense of the employee.
- Yes
- No
File
Do you have a current Drivers Licence?*
Do you have a current Drivers Licence? If yes, please attach copy.
- Yes
- No
File

Essential Key Selection Criteria Answers*
Please detail your response to the Essential Key Selection Criteria as per the Position Description below. Alternatively, you may attach a typed copy to the back of your application.
Desirable Key Selection Criteria Answers*
Please detail your response to the Desirable Key Selection Criteria as per the Position Description. Alternatively, you may attach a typed copy to the back of your application.

All Applications must include a completed Statutory Declaration and Consent Form

All Applications must include a completed Statutory Declaration and Consent Form

Information for Applicants
VPS employees must adhere to standards of conduct and behaviour that exemplify the Public Sector Values prescribed in the Public Administration Act 2004. Public servants occupy positions of trust in the community and are accountable for their actions. As such, all candidates for VPS roles are subject to appropriate integrity checks.
This Statutory Declaration and Consent Form (this Form) must be completed as part of the recruitment process.
Misconduct is defined in the Public Administration Act 2004 as including:
1. contravention of a provision of this Act, the regulations or a binding code of conduct;
2. improper conduct in an official capacity;
3. a contravention, without reasonable excuse, of a lawful direction given to the employee as an employee by a person authorised (whether under this Act or otherwise) to give the direction;
4. a refusal by an employee to perform duties assigned under Part 3 (public service employment) or Part 7A (emergency situations);
5. an employee making improper use of his or her position for personal gain;
6. an employee making improper use of information acquired by him or her by virtue of his or her position to gain personally or for anyone else financial or other benefits or to cause detriment to the public service of the public sector.
The binding Code of Conduct applicable to VPS employees can be found at
NCN Health will protect personal information collected in the course of undertaking employment related checks by restricting its distribution to individuals who require it to make or participate in making an employment decision, and ensuring proper record management procedures are adhered to. NCN Health will comply with relevant privacy legislation requirements. You will be able to gain access to any relevant personal information that NCN Health collects about you throughout the recruitment process.
A preferred applicant with a conduct history (criminal or misconduct) will not necessarily be precluded from employment. The relevance of any information collected will be assessed strictly in relation to the requirements of the position applied for.
NCN Health will determine the relevance of any conduct to the position applied for, taking the following into account:
- the age of the applicant at the time of the conduct
- the nature and seriousness of the conduct
- the relevance of the conduct to the particular position applied for
- the risk to NCN Health and the Victorian community
- the period of time that has elapsed since the conduct took place
- the type and severity of any penalty imposed
- whether there is a pattern of behaviour
- any evidence of rehabilitation including subsequent work experience
- any additional information provided by the applicant, including references from persons who are aware of the conduct history.
NCN Health will conduct any relevant and required checks about applicants and the information you provide with your application. Such checks may include but are not limited to:
- Identity (evidence of name/change of name, DOB, address)
- National and/or international police checks (which may include fingerprinting depending on the role)
- Right to work (including visa, separation package and redeployment status)
- Declarable associations to individuals known or suspected to be involved in unlawful activity
- Disciplinary history (including misconduct, open investigations and findings)
- Working with children
- Qualifications
- Professional registration or licence
- Contacting references to obtain referee statement

*This section must be completed and signed by the witness if the person making the statutory declaration is illiterate, blind or cognitively impaired and the statutory declaration is read to them.
I certify that I read this statutory declaration to [name of the person making the statutory declaration] at the time the statutory declaration was made.*
- I certify that I read this statutory declaration to [name of the person making the statutory declaration] at the time the statutory declaration was made.
*
[signature of authorised statutory declaration witness]
*This section must be completed and signed by the witness if reasonable modifications were used in preparing this statutory declaration and that the contents of this statutory declaration were read to the person making the statutory declaration in a way that was appropriate to the person's circumstances.
I confirm that reasonable modifications were used in preparing this statutory declaration and that the contents of this statutory declaration were read to the person making the statutory declaration in a way that was appropriate to the person's circumstances.*
- I confirm that reasonable modifications were used in preparing this statutory declaration and that the contents of this statutory declaration were read to the person making the statutory declaration in a way that was appropriate to the person's circumstances.
*
[signature of authorised statutory declaration witness]
*This section must be completed and signed by any person who has assisted the person making the statutory declaration, for example by translating the document or reading it aloud. If no assistance was required, this section does not need to be completed.
I certify that I have assisted [name of the person making the statutory declaration] by [specify what assistance was provided, for example translating the document]*
- I certify that I have assisted [name of the person making the statutory declaration] by [specify what assistance was provided, for example translating the document]
*
*
[signature of person providing assistance]
Date*
Date Format: MM slash DD slash YYYY

[date]
*
[full name of person providing assistance]
*
[address of person providing assistance]
Under section 30(3) of the Act the person making the statutory declaration and the statutory declaration witness must, in the presence of each other, sign or initial any alteration to the statutory declaration (s30(3)(a)); sign or initial each page of the statutory declaration (s30(3)(b); sign and date the statutory declaration (s30(3)(d), and legibly write, type or stamp their name and address on the statutory declaration (s30(3)(e)).
The statutory declaration witness must write or stamp under their signature required by ss30(3)(c) and (d) of the Act their qualification as a statutory declaration witness as prescribed by section 6 of the Oaths and Affirmations (Affidavits, Statutory Declarations and Certifications) Regulations 2018 (s30(5) of the Act).
If the person making the declaration has a disability or impairment that prevents them from completing any of the prescribed steps, please contact the Victorian Public Sector Commission (03 7004 7220) for further advice on completing a statutory declaration.

Consent Form
Consent Form*
[FULL NAME]
*
[address]
*
[occupation]
I declared above, consent to the following:
1. I consent to NCN Health gathering information and conducting relevant and required checks about me and the information I have provided in my present application for employment and throughout the recruitment process.
2. I consent to NCN Health contacting my current and previous employer(s) to substantiate my employment history, including regarding past conduct and performance.
3. Should I be successful in this application I consent to the information provided in my present application for employment to be used during my employment for employment related purposes.
Signature of person providing this consent:*
Date on which consent is provided:*
Date Format: MM slash DD slash YYYY
Comments
This field is for validation purposes and should be left unchanged.

Application for Employment

Application for Employment

Step 1 of 8 - Page 1 of 10

All Applications must include a completed Statutory Declaration and Consent Form

All Applications must include a completed Statutory Declaration and Consent Form

Instructions (subject to modifications appropriate to a person's circumstances)

Consent Form

I declared above, consent to the following: