Application for Work Placement

Completion of this form does not guarantee a Work Placement.
Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Tutor details

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{ binding firstError.message }

Driver's licence details

Do you have a current driver's license? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
Do you have any restrictions on your licence? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }

Do you hold any of the following

A current DCSI Child Related Employment Screening {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
A current First Aid Certificate {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
A current CPR Certificate {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
A current Child Safe Environment Certificate {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Are you willing to obtain those you answered no to at your own cost prior to commencing employment? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
Working region (tick all regions that you are available to work in): {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }

Shift Availability (please tick all shifts you are available to work)

Monday {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Tuesday {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Wednesday {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Thursday {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Friday {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Saturday {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Sunday {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Type of service preferred: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }

Please attach a copy of the following documents (if available)

{{ Cognito.resources['fileupload-dropzone-message'] }}
{binding Name, mode=oneTime}
{binding Description}
{ binding firstError.message }
{{ Cognito.resources['fileupload-dropzone-message'] }}
{binding Name, mode=oneTime}
{binding Description}
{ binding firstError.message }
{{ Cognito.resources['fileupload-dropzone-message'] }}
{binding Name, mode=oneTime}
{binding Description}
{ binding firstError.message }
{{ Cognito.resources['fileupload-dropzone-message'] }}
{binding Name, mode=oneTime}
{binding Description}
{ binding firstError.message }
{{ Cognito.resources['fileupload-dropzone-message'] }}
{binding Name, mode=oneTime}
{binding Description}
{ binding firstError.message }
{{ Cognito.resources['fileupload-dropzone-message'] }}
{binding Name, mode=oneTime}
{binding Description}
{ binding firstError.message }
{{ Cognito.resources['fileupload-dropzone-message'] }}
{binding Name, mode=oneTime}
{binding Description}
{ binding firstError.message }
{ binding firstError.message }

Declaration by Applicant

I declare: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }

Application for Work Placement

The email has been sent.

Your progress has been saved.

{ binding firstError.message }

Application for Work Placement

Completion of this form does not guarantee a Work Placement.
Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Date of application {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Email {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Phone {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Mobile Phone {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Current place of study (University/College) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Qualification currently studying {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }

Tutor details

Tutor name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Tutor Phone {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Tutor Email {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
{ binding firstError.message }
Total number of work placement hours required {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Preferred starting date for your work placement {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Please provide details as to why you wish to complete your work placement with Community Living Australia {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }

Driver's licence details

Do you have a current driver's license? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Driver's Licence Number {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Driver's Licence Type {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Driver's Licence Expiry Date {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Do you have any restrictions on your licence? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Please provide details of restriction: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }

Do you hold any of the following

A current DCSI Child Related Employment Screening {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
A current First Aid Certificate {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
A current CPR Certificate {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
A current Child Safe Environment Certificate {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Are you willing to obtain those you answered no to at your own cost prior to commencing employment? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
{ binding firstError.message }
Where did you hear about work placement opportunities with us? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Where did you hear about us? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Working region (tick all regions that you are available to work in): {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }

Shift Availability (please tick all shifts you are available to work)

Monday {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Tuesday {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Wednesday {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Thursday {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Friday {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Saturday {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Sunday {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Type of service preferred: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }

Please attach a copy of the following documents (if available)

Work placement insurance documents from your University/College {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{{ Cognito.resources['fileupload-dropzone-message'] }}
{binding Name, mode=oneTime}
{binding Description}
{ binding firstError.message }
Workplace Agreement from your University/College {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{{ Cognito.resources['fileupload-dropzone-message'] }}
{binding Name, mode=oneTime}
{binding Description}
{ binding firstError.message }
Current DCSI Child-Related Screening Clearance {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{{ Cognito.resources['fileupload-dropzone-message'] }}
{binding Name, mode=oneTime}
{binding Description}
{ binding firstError.message }
Current Driver's Licence {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{{ Cognito.resources['fileupload-dropzone-message'] }}
{binding Name, mode=oneTime}
{binding Description}
{ binding firstError.message }
Current First Aid Certificate {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{{ Cognito.resources['fileupload-dropzone-message'] }}
{binding Name, mode=oneTime}
{binding Description}
{ binding firstError.message }
Current CPR Certificate {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{{ Cognito.resources['fileupload-dropzone-message'] }}
{binding Name, mode=oneTime}
{binding Description}
{ binding firstError.message }
Child Safe Environments Certificate {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{{ Cognito.resources['fileupload-dropzone-message'] }}
{binding Name, mode=oneTime}
{binding Description}
{ binding firstError.message }
{ binding firstError.message }

Declaration by Applicant

I declare: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Date {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
{ binding firstError.message }