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PERSONAL DETAILS FORMPERSONAL DETAILSTitle: FORMTEXT ?????Surname: FORMTEXT ?????Previous Surname (if different): FORMTEXT ?????Given names: FORMTEXT ?????Pref. Name: FORMTEXT ?????Date of birth: FORMTEXT ?????Gender:Choose an item.Residential address: FORMTEXT ?????Postcode: FORMTEXT ?????Postal address (if different): FORMTEXT ?????Postcode: FORMTEXT ?????Home phone: FORMTEXT ?????Mobile: FORMTEXT ?????Linguistic skills(optional):Spoken: FORMTEXT ?????Written: FORMTEXT ?????EMERGENCY CONTACT DETAILSPrimary Emergency contact name: FORMTEXT ?????Relationship: FORMTEXT ?????Residential address: FORMTEXT ?????Postcode: FORMTEXT ?????Home phone: FORMTEXT ?????Mobile: FORMTEXT ?????Additional emergency contacts can be added in the payroll system by the employee once access has been providedSALARY DETAILSPlease take care when completing these details to ensure payment is made to the correct account.(Your pay can be split between a number of accounts but one has to be the primary account where all or the remainder of your pay will be deposited. Additional bank accounts can be added in the payroll system by the employee once access has been provided)1.Primary Bank/Building Society/Credit Union: FORMTEXT ?????BSB or Branch: FORMTEXT ?????Account: FORMTEXT ?????Name of account: FORMTEXT ?????Balance of pay: ?2.Additional Bank/Building Society/Credit Union: FORMTEXT ?????BSB or Branch: FORMTEXT ?????Account: FORMTEXT ?????Name of account: FORMTEXT ?????Specified amount or %: FORMTEXT ?????SUPERANNUATIONIf the ‘Super Choice’ form for your choice of superfund is not completed, you will automatically default to GESB, the superannuation fund for the Western Australia Public Sector. VOLUNTARY SEVERANCEHave you ever received a voluntary severance from the WA Public Sector?? No ? YesIf “Yes”, what is your re-entry date on your Deed of Severance: Enter here RESIDENCY DETAILSAre you an Australian citizen?? No ? YesAre you a permanent resident of Australia?? No ? Yes ? N/A Are you a temporary resident of Australia?? No ? Yes ? N/AIf you are a temporary resident, on what date will your residency expire? Click here to enter a date.Documentation must be provided as proof of the above.I give consent for HR to complete a Visa Entitlement Verification Online (VEVO) check to confirm my entitlement to work in Australia:? No ? Yes ? N/AQUALIFICATION?Doctoral Degree (PHD)?Advanced Degree or Associate Diploma?Year 10 or Equivalent?Master Degree?Diploma Level?Non Award Course?Graduate Diploma?Certificate III or IV?Other (Specify below)?Graduate Certificate?Certificate I or II?Bachelor Degree?Year 12 or equivalentField of Qualification (specify, eg social work, disability services): FORMTEXT ?????DIVERSITYAll questions are optional. The information will be held in confidence on our personnel system and will not be used to identify individuals.These details can be updated in the payroll system by the employee once access has been provided.Do you identify as of Aboriginal or Torres Strait Islander descent?? No ? Yes, Aboriginal ? Yes, Torres Strait Islander ? Yes, both Aboriginal and Torres Strait IslanderDo you have an ongoing disability? ? No ? YesIf Yes, please indicate the nature of your disability: FORMTEXT ?????Does your disability require adjustments in the workplace by your employer? ? No ? Yes If Yes, would you like this information to be made available to appropriate staff so workplace adjustments can be put in place? ? No ? YesDECLARATIONSHEALTHTo the best of your knowledge and belief, are you in sound health? ? No ? YesIf ‘no’, please give details: FORMTEXT ?????DISABILITY/WORKERS’ COMPENSATION CLAIMA disability or injury or previous workers’ compensation claim is not a barrier to the consideration of an applicant for employment. However, please indicate whether you have a disability or injury or workers’ compensation likely to affect your work performance or which could recur or be aggravated by the type of work which you will be required to undertake.? No? YesIf ‘yes’, please give details: FORMTEXT ?????CRIMINAL CONVICTIONSEmployment is subject to a satisfactory National Police Clearance. A criminal record does not necessarily disqualify an applicant. The Disability Services and Child Protection Services and Family Support Divisions are entitled to request Spent Convictions details under Schedule 3 of the Spent Convictions Act 1988.Have you been convicted of any offence in court or are you currently the subject of any charge pending before any court?? No? YesIf ‘yes’, please give details: FORMTEXT ?????I DECLARE THE ABOVE INFORMATION TO BE TRUE IN ALL RESPECTS. I REALISE THAT, IF EMPLOYED, I CAN BE DISMISSED IF THIS INFORMATION IS FOUND TO BE FALSE OR DELIBERATELY MISLEADING.SIGNATUREDATE FORMTEXT ?????DOCUMENTS TO RETURN?Personal Details Form?National Police Clearance/Consent To Obtain Police Check?Tax File Declaration?ICT New User Acknowledgement?Residency Details (if applicable)?Certified Copy Of Qualifications (if applicable)?100 Point Identification Check*?Working With Children Card (if applicable)?Marriage/Change of Name Certificate (if name appears differently on birth certificate or passport)?Working With Children Check Reimbursement Form (if applicable)?Super Choice Form?District Allowance Form (if applicable)* 100 Point Check GuideOne primary document must be provided to confirm Australian citizenship. If you do not have Australian citizenship, evidence of permanent resident status or an entitlement to live and work indefinitely in Australia or a temporary visa with entitlement to work, must be provided.Primary documents?ID documentPoints1Birth Certificate702Australian Citizenship Certificate703Current Passport70Secondary documentsID documentPoints1Australian Photo Driver’s Licence or Australian Learner’s Permit402State or Federal Government Employee Photo Identification403WA Card with photo404Centrelink/Social Security benefits Card255Medicare Card256Council or Shire rates notice257Utilities bill (power / phone / mobile / water / gas)258Motor vehicle Registration or Insurance259Professional or Trade association Card2510Debit/Credit card (bankcard, ATM card, Visa card, MasterCard, etc)2511Passbook or Statement from Financial Institution25?Total points score (including one primary document) must equal 100 pointsEvidence of change of name is required (i.e. Marriage Certificate or Deed Poll) if the name on any of the documents presented is different, as a link between former name and current name.? ................
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