Application Form

Position applied for:*

Preferred Title:*

Surname: *

Given Names:*

Address:*

Phone:*

Email: *

Date of Birth:

day

/

month

/

year

Australian Citizenship: *

If no please provide Visa/Work Permit Number

Please provide your work experience details in chronological order, commencing with your most recently held position

Matrix

Employer

Position Held

From

To

Reason of Leaving

1.

2.

3.

4.

5.

Please provide details of your educational qualifications.

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Qualification Attained

Institution

Year

1.

2.

3.

4.

5.

Current Practicing Certificate No (if applicable)

Contact details for 3 referees, at least 2 should apply to previous employment

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Name

Address

Telephone

1.

2.

3.

Are you willing for us to contact your prevoius employer as a referee?*

Are you legally entilted to work in Australia?*

Are you willing to work weekends?*

Are you willing to work shifts?*

Are you over 18 years of age?*

Do you have a physical restriction which would prevent you from carrying out the functions of the role you have applied for? If so please give details.*

Are you the subject of any criminal charge(s) still pending before a court, or have you been the subject of criminal conviction(s) or finding(s) of guilt before a Court which are not "pardoned, quashed or spent convictions" under Legislation? If YES provide details*

Why do you wish to apply for this position?*

Why do you believe you should be selected for this position?*

1. How have you displayed Anthem Care Values in previous work situations?

Integrity - Being ethically unyielding and honest and inspiring trust by saying what we mean, matching our behaviours to our words and taking responsibility for our actions.*

Respect - Valuing diversity and unique contributions, fostering a trusting open and inclusive environment and treating each person in a manner that reflects Anthem's values. We are dedicated to relationships.*

Care - We bring empathy and understanding to all we do and from this we deliver holistic (physical, social and emotional) care and hope. We are commited to the ideas of mercy, dignity and quality in our caring.*

Consistency - Our consistency of actions, methods, principles, expectations and outcomes exemplifies our quality.*

2. Please respond specifically to each of the selection criteria*

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Disclaimer*

By ticking this box you certify that the information in this application form is correct in every detail. You also accept that if you have given any false information your employment may be discontinued.

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