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1. PERSONAL DETAILS

First Name

Last Name

Gender

Address

Preferred Name

Postcode

Contact Number

2. POSITIONAL REQUIREMENTS The following criteria are the mandatory requirements to fulfil the role of a Disability Support Worker, answering ‘NO’ does not preclude you from applying or attaining a position with Mighty Care Services however each criteria will be required prior to commencement of the role:

Queensland Drivers Licence

Yes or No

Yes No

Queensland Registered Motor Vehicle

Yes or No

Yes No

Comprehensive Car Insurance

Yes or No

Yes No

Blue Card (Working with Children)

Yes or No

Yes No

If ‘YES’, please indicate classification

P, V or E

“P” – Paid “V” – Volunteer “E” – Exemption

Yellow Card (Disability Services)

Yes or No

Yes No

If ‘YES’, please indicate classification

P, or E

“P” – Paid “E” – Exemption

For the purposes of obtaining a Blue / Yellow Card, are you a disqualified persons?

Yes or No

Yes No

* NOTE: Convicted of a disqualifying offence, is subject of reporting obligations, disqualification order or sexual offender – see www.bluecard.qld.gov.au for full definition.

The following criteria are the desirable requirements to fulfil the role of a Disability Support Worker, answering ‘NO’ does not preclude you from applying or attaining a position with Mighty Care Services:

First Aid Certificate (issued within the last 3yrs)

Yes or No

Yes No

CPR Certificate (issued within the last 1yr)

Yes or No

Yes No

Covid-19 Immunisation Certificate

Yes or No

Yes No

Do you have any additional competencies related to the role?

Yes or No

Yes No

If ‘YES’, please indicate below:

Certs

Cert III Disability Cert III Youth Work (or Higher) Cert III Community Services (or Higher) Cert III Child, Youth & Family (Or Higher Cert IV Disability (or higher)

Other

3. AVAILABILITY AND COMPETENCY

Whilst we understand that applicants may be presently employed, we would like to gauge your future rostering availability should your application be successful.

Monday Morning

Yes or No

Yes No

Monday Afternoon

Yes or No

Yes No

Monday Sleepover Shift

Yes or No

Yes No

Tuesday Morning

Yes or No

Yes No

Tuesday Afternoon

Yes or No

Yes No

Tuesday Sleepover Shift

Yes or No

Yes No

Wednesday Morning

Yes or No

Yes No

Wednesday Afternoon

Yes or No

Yes No

Wednesday Sleepover Shift

Yes or No

Yes No

Thursday Morning

Yes or No

Yes No

Thursday Afternoon

Yes or No

Yes No

Thursday Sleepover Shift

Yes or No

Yes No

Friday Morning

Yes or No

Yes No

Friday Afternoon

Yes or No

Yes No

Friday Sleepover Shift

Yes or No

Yes No

Saturday Morning

Yes or No

Yes No

Saturday Afternoon

Yes or No

Yes No

Saturday Sleepover Shift

Yes or No

Yes No

Sunday Morning

Yes or No

Yes No

Sunday Afternoon

Yes or No

Yes No

Sunday Sleepover Shift

Yes or No

Yes No

Health Condition

Yes or No

Yes No

If ‘YES’, please indicate below:

Do you have any Client Related skills and/or experience?

Yes or No

Yes No

Are you prepared to undertake all of the above related skills area should you be required, and are competent to do so?

Yes or No

Yes No

If ‘NO’, please provide details here

Do you have any areas within Disabilities that you have a strength or special interest in?

Yes or No

Yes No

If ‘YES’, please provide details here

4. SELF EVALUATION

Why do you think you are the right person to join the team at Mighty Care Services?

What “hands on” experience do you have supporting people with disabilities?

What are some of the things you may need to be aware of when supporting a person with a disability in their own home?

What are your key attributes and values that you feel make you a good Disability Support Worker?

List some examples of how, or actions you have taken to uphold Professional Boundaries in previous roles:

What is your understanding and awareness of the health and safety requirements when supporting a person with a disability?

Any additional comments?

START DATE

I am available for an immediate start?

Yes or No

Yes No

If ‘NO’, please indicate the notice period required for your current position below:

Notice period

1 Week 2 Weeks 3 Weeks 4 Weeks

Other timeframe - please specify here

5. DECLARATION

In signing this application for employment, I fully understand that any false, misleading or incomplete information stated by me in this application may lead to grounds for termination if employed by Mighty Care Services. I also acknowledge that submitting this application is not a guarantee of employment with Mighty Care Services.

I certify that the information stated in this application is true and correct

I certify that the information stated in this application is true and correct;

Please select date

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Mighty Care Services would like to acknowledge the Traditional Custodians of the land on which we operate, the Yuggera, Jagera, and Ugarapul peoples. We pay our respects to their Elders past, present and emerging, and extend that respect to all Aboriginal and Torres Strait Islander peoples. We recognise their deep and continuing connection to this land, its waters and its stories.

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