Casual Registration Form

First Name *

Last Name *

Please select which positions your have experience in: *

Patient Services Assistant Personal Care Worker Food Services Assistant Cleaner

Email Address *

Address *

Suburb *

Postcode *

Contact Number *

Date Of Birth *

Please select your right to work status *

Please attach a copy of your PASSPORT. If you don't have a passport attach both BIRTH CERTIFICATE OR AUSTRALIAN CITIZENSHIP AND DRIVERS LICENCE (or other photo ID) *

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If you have a Police Check (issued no more than 3 years ago) please upload a copy

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If you have a CURRENT Working With Children's Check please upload a copy

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If you have had a flu vaccine administrated please upload evidence of vaccine

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If you are registered with JOB ACTIVE please provide JOB SEEKER NUMBER & PROVIDER

PROOF OF COVID19 VACCINATION

The state government of Victoria introduced the mandating of vaccines for Residential Aged Care & Healthcare Facilities under Victoria’s Public Health andWellbeing Act and associated state-of-emergency powers.

How do I obtain proof if I have been fully or exempt from COVID19 Vaccination?

Fully Vaccinated (2 doses, boosters included). Your Immunisation History Statement or COVID-19 digital certificate shows proof of only your COVID- 19 vaccinations.
If you have a medical exemption from the COVID19 Vaccination please provide proof of evidence obtained by an authorised health professional.

Please select ONE of the options as they apply to your current vaccination status: *

If you are fully vaccinated (had 2 doses) OR had your 3rd booster please upload proof of your vaccination status. PLEASE NOTE A PHOTO OF THE VACCINATION CARD IS NOT ACCEPTABLE *

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If you have a medical exemption from COVID19 Vaccination please upload proof from an authorised medical professional *

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Emergency Contact Details

Name of emergency contact *

Relationship to you *

Contact number of emergency contact *

1st Referee Information

Name of company you worked with the referee *

Referee contact name & position title *

Referee phone number & also email address if you have it *

Did a recruitment agency place you in this role.? *

YesNo

2nd Referee Information

Name of company you worked with the referee *

Referee contact name & position title *

Referee phone number & also email address if you have it *

Did a recruitment agency place you in this role?

YesNo

APPLICATION AGREEMENT

It is a requirement of your employment that you must read the application agreement: The application agreement outlines your requirements & Symmetry's requirements to you.It can also include paragraphs.

By signing this application you are confirming that you have:

Advised Symmetry Human Resources of all health issues past and present that may affect your availability to perform safely any position offered to you.
Provided full and accurate information in the application and on your resume.
Authorised Symmetry Human Resources to check with whomever we deem necessary to verify your employment.
Authorise Symmetry Human Resources to retain your personal information in our database for the purpose of offering you casual and permanent employment opportunities.
Authorise Symmetry Human Resources to provide other employers with information relating to your work performance.

I agree that I am employed as a Casual employee and if I am assigned casual employment I agree only to be paid for the hours that actually have been worked.

I understand that my pay includes a casual loading that is in lieu of annual leave, leave loading, sick leave and other loading that may apply to a permanent employees pay. I understand that the rate of pay I receive will not be less than the National Minimum Wage. I understand the payment of a rate of pay on any particular job assignment does not provide me with the right to continuing payment of such rates of pay on alternative job assignments.

I understand as a casual employee of Symmetry Human Resources may change or terminate assignments with one hours notice and I have no right to on-going employment on any particular job assignment.

In the event that I am injured at work I authorise you to speak with my treating medical practitioner and agree to attend Symmetry Human Resources medical practitioner for a second medical opinion.

I authorise Symmetry Human Resources or its agents to undertake checks on my employment history and agree that all information I have provided to Symmetry Human Resources is accurate.

The privacy policy for Symmetry Human Resources can be viewed on our website – www.symmetryhr.com.au

YOUR HEALTH & SAFETY

The following is a request for information. You are not obliged to answer the following questions. The information provided will be used to assist us in your placement and will remain confidential.

Are you aware of any medical condition which would be made worse or put you or other workers at an increased risk by any particular work? If YES, please provide details. If NO, write no medical conditions *

Are you able to read and understand safety and warning signs in the workplace? Are you able to hear warning signs or alarms in the work place? *

YesNo

Your weight:

Your height:

Note: The above question is asked as Symmetry work with some clients whereby the nature of the position being performed may have potential health risks associated with the job along with your ability to perform the specific elements of the job.

Have you had any illness that has caused you to take more than one week off work in the last 5 years? If YES, please provide details. If NO, write no illnesses *

Have you ever had trouble with wearing gloves or other personal protective equipment? *

Please list all WorkCover claims you have had in the last 5 years. Ensure to include the injury date, nature of injury/illness, time off work and if you have fully recovered. If no claims, write no claims. *

Please list any existing condition(s) to your back, shoulders, knees, wrists or any other part of your body which could be aggravated by work. If no conditions write no existing conditions. *

Do you take any medication or substance (obtained by prescription, over the counter, or otherwise) that either advises against or may affect your ability to drive or use machinery? *

Are you at present receiving treatment for any condition arising from your present or previous occupations?

Do you suffer from a psychological disorder that affects your employment? *

Please list any other conditions or complaints that you suffer from which were not specified on the list. If no conditions or complaints, write no conditions or complaints. *

PRE-EXISTING INJURY OR DISEASE DECLARATION

It is a requirement of your employment that you must read the Pre-Existing Injury or Disease Declaration by clicking on the link below. Once you have read the agreement tick the box below.

In making this disclosure, please refer to the position description provided, which describes the nature of the employment. It includes a list of responsibilities and 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 possible or practical.

Please note that, if you fail to disclose this information or if you provide false and misleading information in relation to this issue, you and your dependants may not be entitled to any form of workers’ compensation as a result of the recurrence, 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 the company may constitute grounds for disciplinary action or dismissal.

APPLICANTS DECLARATION

I declare that:

I have read and understood this form and the attached/included position description, and have discussed the employment with the company. I understand the responsibilities and physical demands of the employment.
I acknowledge that I am required to disclose all pre-existing conditions which I believe 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 disentitling 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 may arise out of or in the course of the employment.

Please select ONE of the following statements that applies to you: *

If you selected that you do have suffered conditions that may recur or deteriorate,accelerate or be exacerbated or aggravated by the employment, please list conditions here:

Please read the below to confirm submission of your application form

I acknowledge and declare that the information provided in this form is true and correct in every particular. I also confirm that the form was completed by myself, as the intended recipient of Symmetry Human Resources. *

Please sign your signature *

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First name & Surname of person who signed this form: *