daughterly care community services caregiver employment ...€¦ · 2019 august employment...

2019 August Employment Registration Form without wages.docx 1

Daughterly Care Community Services

Caregiver Employment Application Form

1. Please complete the Employment Application Form.

2. Email it to [email protected] Alternatively, post it to Po Box 670, Narrabeen NSW 2101

3. If you are successful with your application, the Recruitment Manager will be in contact

with you to organise an interview.

4. During your interview, you will be asked to provide the following documentation. Please

note – these items can be provided ‘after your initial interview’, however until you supply

these items, you cannot commence work with Daughterly Care.

CHECKLIST Your Action

If you are not an Australian resident: current work visa & passport □ Yes □ No

Current First Aid Certificate (this can be obtained within your first 3 months of employment)

□ Yes □ No

Current Police Check paperwork (the expiry date cannot be less than 3 months old)

□ Yes □ No

Current Working with Children Check paperwork – it must have a code E for paid work, not V for volunteer

□ Yes □ No

Original Driver’s Licence (we will photocopy the original)

□ Yes □ No

Copy of your car registration □ Yes □ No

Copy of your car insurance □ Yes □ No

Details of your superfund details including account & spin numbers □ Yes □ No

Your Tax file number (to fill out on the ATO Tax Declaration Form) □ Yes □ No

Your Bank details (bank account name, Bank name/state, BSB number for your bank) where you would like to be paid into

□ Yes □ No

Copy of Training Certificates, Other Qualification Certificates □ Yes □ No

Copy of written references from previous employers □ Yes □ No

mailto:[email protected]


Daughterly Care Community Services Caregiver Employment Application Form

Thank you for applying for a position with Daughterly Care Community Services Limited.

Daughterly Care Community Services specialises in providing care for older people and people living

with dementia, living in the community.

1. 1. Personal Details

First Name Middle Name

Surname Date of Birth

Home Address

Postal Address

Email

Mobile number Country of birth

Are you an Australian Citizen or Permanent Resident?

(please provide the original at your interview)

Note – we do not employ people on student visas

Australian citizen Australian resident

If Yes, have you been a citizen or permanent resident of a country other than Australia since turning 16? Yes No

If yes, which country? ______________________________

If no, do you have a current work visa? Yes No

What date does your work visa expire? ______/______/______

2. 2. Documents required for employment

Do you hold a current First Aid Certificate?

Yes - If yes, bring a copy to your interview

No – If no, you will need to obtain your First Aid Certificate within 3 months of

employment

Do you hold a current Police Clearance Certificate?


No – If no, please go to https://npcoapr.police.nsw.gov.au or go to your local Post Office

to obtain a form.

Do you hold a current Working with Children Check?


No - please go to www.newcheck.kids.nsw.gov.au to obtain one and bring the receipt

with you to your interview. Please make sure you choose the Paid option (not volunteer).

Do you hold a current Driver’s Licence?

Yes - If yes, bring the original to your interview

No

Do you have car insurance & car registration papers

Yes - If yes, bring a copy of the paperwork to your interview. What type of car insurance do you have: CTP Third party Fully Comprehensive No

Do you have a car you can use for work?

Yes No

Would you feel comfortable driving a client’s car?

Yes No Maybe

https://npcoapr.police.nsw.gov.au/

http://www.newcheck.kids.nsw.gov.au/


3. 3. More about you

Will Daughterly Care be your only employer? Yes No If no, who will you be working for as well as for Daughterly Care? ___________________________________________________________________________________________ If no, how many hours/days will you be working for the other employer? ___________________________________________________________________________________________ If no, who will be your main source of income? Daughterly Care Your other employer

How did you hear about Daughterly Care?

Daughterly Care staff member: _______________________________________

Newspaper press advertisement: _______________________________________

Daughterly Care Client Facebook Health Professional

Noticeboard Daughterly Care Website

Other _____________________________________________________________

How would you prefer to receive your timesheet (most caregivers choose email):

Email newsletters Post newsletters Email timesheets Post timesheets Please note - Australia Post (takes between 2-5 working days) Please note – to receive timesheets by email you MUST have a printer

Do you speak any languages other than English:

Yes No If Yes please state: ____________________________________________________

Do you feel comfortable caring for older people living with memory loss /confusion/dementia?

Yes No If No please state why: ____________________________________________________________________

Do you smoke?

Yes – if yes: How many per hour? _______________ Per day? _____________

Do you wear a patch while working with clients? Yes No

Do you smoke in your car? Yes No

No, I do not smoke

Do you have any allergies?

Yes – if yes, please describe your allergies ________________________________ ____________________________________________________________________ No


4. Health & Wellbeing (legally you are required to answer these questions accurately and truthfully):

Do you have osteoporosis?

No Yes – if yes, please describe your condition___________________________

_______________________________________________________________________

Do you, or have you ever had a bad back/ neck?

No Yes Yes, but I’m careful not to do anything at work that might aggravate it If yes, please describe _____________________________________________________

_______________________________________________________________________

Do you have a bad shoulder, leg, knee, hip or bulging spinal discs?


_______________________________________________________________________

Do you, or have you ever had any other injuries or disabilities that we should take into consideration when scheduling you for work?


_______________________________________________________________________

_______________________________________________________________________

Do you have an existing physical, medical or psychiatric condition that we may need to take into consideration when scheduling your work?


_______________________________________________________________________

_______________________________________________________________________

Have you ever claimed Worker’s Compensation in a previous role? Please note - we may need you to visit our Doctor and also speak to your Doctor to ensure you are fit to work for Daughterly Care Community Services.

No Yes – if yes, please provide a copy of your final ‘fit for pre-injuries medical certificate’ plus the following details:

o Describe how the injury happened? _______________________________________

____________________________________________________________________

o What date did the injury happen? _________________________________________ o How much time did you have off work? ____________________________________ o How much time were you on suitable duties? _______________________________

o If you were on suitable duties, how many hours did you work per week?__________

o What restrictions or limitations did you have on your certificate? _______________

____________________________________________________________________

o What date did you come off Workers Compensation? _________________________

Please Be Aware Of Section 79 Worker’s Compensation Board And Assistance Act 1981

Where it is proved that the worker has, at the time of seeking or entering employment in respect of which she/he claims compensation for a disability, wilfully and falsely represented himself/herself as not having previously suffered from the disability, the Board may in its discretion refuse to award compensation which otherwise would be payable. I acknowledge completely that the deliberate giving of false information, with respect to any of the above areas, shall lead to dismissal. Name: ______________________________ Signature: __________________________


4. 5. Employment History - current and previous roles

Current or Previous Employer details

Name of employer/previous employer

Your position title

Person you report(ed) directly to

Dates you were/are employed From ____________________ To ____________________

Are you currently employed with this employer?

Yes No

If no, reason for leaving (if applicable)

Do you have a written statement of employment or reference from this employer?

Yes No

Employer phone number/contact name

Employer 2

Name of previous employer

Your position title

Person you reported directly to

Dates you were employed From ____________________ To ____________________

Reason for leaving


Yes No


Employer 3

Name of previous employer

Your position title

Person you reported directly to

Dates you were employed From ______________________ To ______________________

Reason for leaving


Yes No


Other

Is there any prior employment, in addition to the above 3 positions that is relevant to caring for older people in their home, i.e. volunteer or cared for a loved one?


5. 6. Your work interests and rate of pay

Please consider the following and let us know what you prefer:

HOURLY work:

o Are you looking to work a few hours each day?

o Are you happy to do morning services (e.g breakfast, showering, appointments, etc) or evening services (dinner, showering, companionship, etc).

o Please note with hourly work, each job is 2 hours minimum and we aim to run them back to back. You are paid mileage for kilometres in between immediately successive jobs (within an hour).

o With hourly work, we aim to give you a mix of regular ‘ongoing’, short term and one off clients.

o Working with older people, their needs change quickly, so we employ you as a casual caregiver.

o When people first start with us, they generally receive one off and short term work and we build up their ‘ongoing’ clients over time.

o We have many staff who have worked as ‘ongoing casuals’ for over 10 years and received long service leave.

o We are an employer of professional carers who choose to stay with us.

LIVE-IN care work:

o Are you an exceptional, highly experienced in-home carer wanting to care for high care clients in their SYDNEY home.

o Are you looking at living in the client’s home for a few days per week (from 3 to 5 days a week with the same client)?

6. 7. Your work availability

Please indicate with a tick what type of work you are willing to do for Daughterly Care Community Services:

Respite / appointments/ basic personal care?

Light housekeeping and home help?

Live in – at the client’s home? Overnight care?

Yes No Yes No Yes No Yes No

Please indicate when you are available to work for us:

Daughterly Care Community Services provides services 7 days a week, day and night, overnight and on a live-in basis.

We try our best to match the hours that you want to work with the work we have available.

Are you looking at working on an Hourly Basis or Living in a client’s home for 24 hours?

If you are planning on providing 24 hour Live-in care work, enter the days of the week you are available: Please note – you must have 4+ years’ experience to work as a Live-in Carer

I am available for Live-in/24 hour’s work. Note: you have the option to work 3 to 7 days a week.

Mon Tue Wed Thu Fri Sat Sun

If you are planning on providing Hourly care work, enter the days of the week you are available:

Enter days & times you can work Mon Tue Wed Thu Fri Sat Sun

I am available for Hourly work on these days

The earliest Start Time for hourly work

The latest Finishing Time for hourly work

Ideally, how many hours per week do you want to work for Daughterly Care?


6. 7. Your work availability

Do you have a limit on the number of hours you can work e.g. you are on a pension or have visa requirements? If yes, please state the number of hours you can work a week so we can stick to your limit

Yes No

How far are you prepared to drive for a 2 hour job? How far are you prepared to drive for a 4 hour job?

Tick below (which is applicable)

Definitely NOT available to work on this day

MAY be available to work (need to be negotiated)

Available for INACTIVE Sleepovers

Available ACTIVE Sleepovers

Annual leave

Do you have any time off planned in the next 3 months that we need to plan around?

If yes, please give details:

Yes No

7. 8. Your skills and experience

Please indicate with a tick what type of experience applies to you:

Task Have had

experience

No experience, but would feel comfortable

trying

NOT comfortable

doing

Personal Care experience

Assist showering FEMALE client (client can wash some parts of their body,

you need to wash rest)

Assist showering MALE client (client can wash some parts of their body, you

need to wash the rest)

Full shower - FEMALE client (client cannot wash any parts of their body so

you need to)

Full shower - MALE client (client cannot wash any parts of their body so you

need to)

Dressing FEMALE client

Dressing MALE client

Assist FEMALE client to toilet (taking to toilet, assisting to sit properly on

toilet, steady when client stands, help pull up pants – client wipes themselves)

Assist MALE client to toilet (taking to the toilet, assisting to sit properly on

toilet, steady when client stands, help pull up pants – client wipes themselves)

Full assistance to FEMALE client with toileting (i.e. as above plus wipe the

client)

Full assistance to MALE client with toileting (i.e. as above plus wipe the

client)

Assisting FEMALE client to change pad (steady client and help pull up pad)

Assisting MALE client to change pad (steady client and help pull up pad)

Full assistance to FEMALE client to put pad on (i.e. you put on and pull up)

Full assistance to MALE client to put pad on (i.e. you put on and pull up)



Task Have had

experience

No experience, but would feel comfortable

trying

NOT comfortable

doing

More Complex Personal Care (Note: These skills are not needed to care for most of our clients, however if you have this experience we would like to know)

Changing urine catheter bags

Changing colostomy bowel bag

Taking blood sugar levels (i.e. prick finger for blood)

Using Kylie Sheet on bed

Doing pressure area care e.g. rubbing cream, ensuring pressure kept off area

Putting tablet under tongue e.g. for Angina Pain

Monitoring seizures

Tube peg feeds

Giving bed sponges

Placing client on bed pan

Transfers Experience

Able to help client transfer

Experienced to transfer client by hoist – full hoist and standing hoist, i.e. knowledge of different sling & standing hoist

Experienced using Pelican Belt

Experienced rolling, turning client in bed with slide sheet

Dementia Experience

Experienced with early onset dementia

Capable of handling reactive behaviours associated with dementia (challenging behaviours)

Capable of caring for 2 dementia clients at once

Basic Palliative Care Experience

Basic knowledge of medication

Oral hygiene

Skin care

Different stages of end of life

Knowledge of palliative end of life stage

Disabilities Experience

Caring for physically disabled children / adults Yes No

Caring for intellectually disabled children / adults Yes No

Caring for adults with mental health issues Yes No



Clients you will care for

Will you care for a client who smokes

IN their home?

Yes No Run it past me – maybe, maybe not

Type of clients you won’t work with or type of work you won’t do?

Will you work with pets? Yes – I love pets Yes, if safe No. If no, state why (e.g. allergic):

Are you comfortable visiting a client in a nursing home e.g. assisting them to eat, taking them for

a walk etc.? Yes No

Number of Years of Experience No. of Years

Total number of years you have been paid/employed to care for older people

Total number of years you have cared for people diagnosed with a form of dementia

Total number of years you have cared for newborns/toddlers/children

Unpaid family experience

Caring for new born babies and toddlers Yes No

Cared for a parent/family member:

Yes No If yes, what was your role and how often did you care for them? Please be specific and list tasks you undertook:

Please tick which aged care qualifications you hold?

(Please provide

copies of any of

your Certificate at

your interview

None

Dementia Essentials

Partial Certificate III (Certificate of Attainment)

Certificate III Assistant in Nursing

Certificate III in Community Care

Certificate III in Aged Care

Certificate III in Allied Health Assistance

Certificate III in Individual Support (Disability)

Certificate III in Individual Support (Ageing, Home & Community)

Certificate IV in Ageing Support

Certificate IV in Community Services

Ex-Registered Nurse (registration not current)

Currently enrolled in Nurse

Registered Nurse (registration current)

Enrolled Nurse (registration current)

Endorsed Enrolled Nurse

Mothercraft Nurse/Midwife

Certificate IV in Disabilities

Nanny

Other than Aged Care Qualifications (please list):

________________________________________________________________________

Have you completed manual handling training? If Yes, please provide a copy of your certificate Yes No

Are you willing to undergo training paid by DCCS? Yes No

https://www.nbcc.nsw.edu.au/course/Allied_Health_HLT33015

https://www.nbcc.nsw.edu.au/course/Individual_Support_DIS_CHC33015

https://www.nbcc.nsw.edu.au/course/Individual_Support_AGED_CHC33015

https://www.nbcc.nsw.edu.au/course/Ageing_Support_CHC43015

https://www.nbcc.nsw.edu.au/course/Community_Services_CHC42015



Cooking Experience

Name 3 meals you would feel comfortable cooking for older people that you feel an older person would enjoy:

1.

2.

3.

Are you vegetarian or vegan? Yes No

Are you comfortable cooking meat for clients? Yes No

Musical Abilities

Can you play any musical instruments? If Yes, please state what type of musical instrument:

Yes No

Can you sing to clients? Yes No

Do you have any special skills, interests, hobbies, passions that might help us match you to clients?

If Yes, please state: Yes No

8. 9. ONLY FILL THIS SECTION - If you are applying for Live-in Care work

Do you like to keep a client’s home to a professional level of cleanliness?

Yes No

Do you have dependent children or animals living with you? If yes, what arrangements will be in place to care for them in your absence, please explain:

Yes No

Once a client accepts you and you like caring for the client, live-in-care tends to be regular on-going work, are you able to commit to regular ongoing work? If yes, please explain:

Yes No

9. 10. Dementia questions:

If a client repeats herself constantly, how do you handle that?

If you were told the main role of your service is to provide a meal for a client and ensure they ate the meal but the client refused to eat saying they have eaten (but you know they haven’t), what would you do you?



If a client living in the community refused to let you in for a service, what might you say to get in to do the service?

10. 11. Please list 3 references

We will be calling the following people you nominate as a reference. They need to be people who you directly reported to who can make comments about your work experience, skills and abilities. Examples can be managers, co-ordinators, rostering/scheduling, etc. Please let them know we will be calling them.

11. Referee No 1

Referee’s Name

Referee’s Email

Referee’s Contact Number

Employer’s Company Name

Employer’s Position (in relation to you)

12. Referee No 2

Referee’s Name

Referee’s Email




13. Referee No 3

Referee’s Name

Referee’s Email





14. 12. Any previous convictions?

If you have been found guilty or have charges pending for theft, fraud, serious driving offences or any form of aggression towards another person please do not apply for a position with us. We will not employ you. To be employed by us you must have a Police Check that is less than three months old. We check on our new staff every month for their first 12 months of employment. So if you have pending charges, please don’t apply for work with us. You may want to apply for this, as it can take some time to process.

Have you been subject to disciplinary proceedings for misconduct or terminated by an employer? If yes, please provide details:

Yes No

Have you EVER been convicted of theft, fraud, poor driving, drugs, drink driving, assault or aggression to another person? If yes, please provide details:

Yes No

Are you under Police investigation or have police charges pending for theft, drugs, fraud, poor driving, and drink driving or aggravated assault to another person? If yes, please provide details:

Yes No

15. 13. Your Declaration

By signing this application I confirm that the details in this application are correct and I have informed you of all matters of significance. I understand that providing false information, including omitting relevant information in my application form will result in instant dismissal. I authorise investigation of all statements in this application form and reference list.

Name: __________________________________ Signature: __________________________________

16. 14. The Next Step

Thank you for taking the time to complete this application. Please email your completed employment application form to: [email protected]

Alternatively please mail your employment application form to: Vera Hannan, Recruitment Manager

Daughterly Care Community Services Ltd

PO Box 670

Narrabeen NSW 2101

Our phone number is (02) 9970-7333 for a confidential chat about the role you are applying for.

mailto:[email protected]