EMPLOYMENT APPLICATION FORMJob Title:

Closing date for applications:

APPLICANT PERSONAL DETAILS Please indicate your legal work status:

Australian Citizen New Zealand Citizen Australian/New Zealand Resident

Current Working Visa Require Sponsorship Other

Visa Expiry (if applicable):

Title: First Name: Last Name:

Email Address:

Residential Address: Suburb/Town:

State: Postcode: Country:

Phone Number:

REFEREES Referee 1. Name: Position Title:

Company:

Relationship to Applicant:

Contact Number: Suburb/Town:

Is the referee aware of your application? Yes. No.

Referee 2. Name: Position Title:

Company:

Relationship to Applicant:

Contact Number: Suburb/Town:

Is the referee aware of your application? Yes. No.

GENERAL INFORMATIONHow did you hear about this position?

Seek NRMJobs.com.au Great South Coast Jobs

Newspaper (please specify)

Other (please specify)

The following questions are used primarily for statistical purposes:

Do you identify as being Aboriginal or Torres Strait Islander? Yes. No.

Do you have a disability? Yes. No.

What is your country of birth?

To enable Corangamite CMA to provide a safe working environment and not exacerbate any current conditions, are there any pre-existing illnesses, injuries or medical conditions which may prevent you from performing the inherent requirements of this role? Yes. No.

If yes, please specify)

Do you hold a valid Victorian Drivers Licence? Yes. No.

Do you hold a current Working With Children Check? Yes. No.

CANDIDATE DECLARATIONI declare that all information provided is true and correct:

Signature: Date: