Employment Application

Join our friendly team and share our commitment to provide quality service in a caring and supportive environment.


Position Description


Full Time Part Time Casual 

Part-Time Availability

6 Shifts / Fortnight 8 Shifts / Fortnight 

Have you been employed by CaSPA Care Claremont Home or CaSPA Care South Port before?

No Yes 

If yes, when:


(* required fields)

Please attach your resume with this application*

Personal Details

(* required fields)


Mr Mrs Ms Miss Other 


Given Name(s)*

Address Line 1*

Address Line 2


Your Email*

Phone Number*

Are you an Australian citizen or a permanent resident of Australia?

Yes No 

If Yes, please attach evidence:

If no, do you hold a Visa to work in Australia?

Yes No 

If Yes, please attach evidence:

Do you give permission for CaSPA Care to check Visa Entitlement Verification Online for your work eligibility?

Yes No  (If you are not eligible for work in Australia this application cannot be accepted)

Languages Spoken

Person to Notify in Emergency

Full Name


Phone Number (Home)

Phone Number (Business)

Phone Number (Mobile)

Employment History



Employment Duration

Reason for Leaving

Professional References

Contact Name


Employment Relationship

Phone Number



Please attach evidence:

If Other, please specify:

Current AHPRA Registration No.



Do you have any past or current medical condition which may affect your performance in your role or which may be aggravated or worsened by the duties of the role?

Yes No 

If Yes, describe in detail:

Pre-existing Injury Declaration

In accordance with s82(7)-­‐(9) of the Accident Compensation Act 1985 (Vic) ('the Act"), you are required to disclose any or all pre-­‐existing injuries, illnesses or diseases ("pre-­‐existing conditions") suffered by you which could be accelerated, exacerbated, aggravated or caused to recur or deteriorate by you performing the responsibilities associated with the employment for which you are applying with South Port Community Residential Home (Inc).

In making this disclosure, please refer to the relevant position description, which describes the nature of the employment. It includes a list of responsibilities and some details as to the physical demands associated with the employment.

Where you have a pre-­‐existing condition, consideration will be given to reasonable modification to the environment or tasks if at all possible or practicable.

Please note that, if you fail to disclose this information or if you provide false and misleading information in relation to mis issue, under s82(8) and s82(9) of the Act you and your dependants may not de entitled to any form of workers’ compensation as a result of the reoccurrence, aggravation, acceleration, exacerbation or deterioration of a pre existing condition arising out of, in the course of, or due to the nature of your employment. Please also note that the giving of false information in relation to your application for employment with CaSPA Care may constitute grounds for disciplinary action or dismissal.

Employee Declaration

I declare that:

• I have read and understood this form. I understand the responsibilities and physical demands of the employment.

• I acknowledge that I am required to disclose all pre-­‐existing conditions which may be affected by me undertaking the employment.

• I acknowledge that failure to disclose this information or providing false and misleading information may result in invoking section 82(7)-­‐(9) of the Accident Compensation Act 1985 (Vic) which may disentitle me or my dependants from receiving any workers' compensation benefits relating to any recurrence, aggravation, acceleration, exacerbation or deterioration of any pre-­‐existing condition which I may have arising out of or in the course of, the employment.

I have read and understood this form and agree to as stated above. 

Information for Applicants

CaSPA Care reserves the right to check details given on this form with previous employers, although no approach will be made to your present employer without your consent. Employment is subject to a 6 month probationary period & of meeting satisfactory police check requirements for Aged Care.


I hereby affirm that all of the information given by me in this application for employment is true & correct & that I have not knowingly withheld any facts or circumstances that would, if disclosed, affect my application. I understand that a probationary period which will be outlined in a letter of offer, should an offer be made, will apply & that either party may terminate employment without notice during the probationary period. I understand that if employed I shall work to CaSPA Care’s policies & procedures. I understand that deliberate inaccuracies or omissions may result in non-­‐acceptance of this application and/or disciplinary action which may lead to the termination of employment.

I have read and understood this form and agree to as stated above.