Vocational Placement Application Form

Please use this form to apply for a vocational placement with ac.care.

As a not for profit organisation we are committed to supporting education, however due to the high demand, all placements are subject to availability. Before you complete this application, please ensure you have had a look at the different programs and regions in which we operate on our website (NB: ac.care does not provide aged care or disability services.)

Please email your completed electronic form, along with a current resume to careers@accare.org.au. We will assess current capacity for placements in your preferred region and areas of interest and contact you if an opportunity is available. Thank you for your interest in ac.care.

Student Personal Details

Last name:	Home Ph.
First names:	Mobile Ph.
Preferred name:	DOB:
Address:	Postcode:
Gender/Pronoun:
Email:

Education Details

Education Provider:
Course Name:
Stage/Year Level:
Year expected to Graduate:
Course Coordinators Name:
Course Coordinators Phone:
Course Coordinators Email:
Particular area of interest
Is the placement a research project?	Yes No

Placement Details

Placement Start Date:	Click or tap to enter a date.
Placement End Date:	Click or tap to enter a date.
No. of placement hours to be completed:
Number of days per week:	Mon Tue Wed Thu Fri
Is there any additional information that you would like to add?

Other Details

Are you a previous or current ac.care employee?	Yes No
Are you an Australian Citizen or permanent resident	Yes No
Do you identify as Aboriginal or Torres Strait Islander?	Choose an item.
Do you have a current drivers’ licences?	Yes No	Licence No.: Expiry Date:
Do you have a current National Police Check? (Completed within the last 12 months)	Yes No
ac.care requires all volunteers, including students undertaking Vocational Placement, to hold a valid COVID-19 Digital Vaccination Certificate (PDF) accessed through MyGov/Medicare. If you do not have evidence of a valid COVID-19 vaccination you will not be able to undertake volunteering with ac.care.	Evidence provided: Yes No Document No.:

Pre-Placement Declaration

In order to be considered for placement in any capacity at ac.care, you must complete all components of this declaration, including additional, supporting information and documentation where a yes response has been recorded. You will not be considered for placement unless you complete the declaration and provide comprehensive and complete information as necessary.

If you have any questions about the declaration and/or as to supporting information, please contact HR@accare.org.au

The information provided will be treated as confidential and dealt with in accordance with the State Records Act 1997, the destruction schedules issued under that Act

Section 1: Mandatory Certificates and Training

Department of Human Services (DHS) – Working with Children Check (WWCC)	Copy Attached	Expiry Date:	Click or tap to enter a date.
Safe Environments - Through their Eyes	Copy Attached	Expiry Date:	Click or tap to enter a date.

SECTION 2: Pre-Employment Declaration

To be eligible to receive an offer of placement with ac.care you must complete a pre-employment declaration. You may also be required to agree to other pre-placement processes.

Information in this declaration and other pre-placement processes is necessary to assess the suitability of applicants to be offered placement within ac.care.

Some information is necessary to seek to ensure that ac.care and responsible officers comply with their obligations under the Work Health and Safety Act 2012. Some information is required to ensure ac.care meets workplace diversity targets.

You should be aware that the definition of misconduct in the ac.care Performance & Discipline Policy includes concealment of information and providing a false statement in connection with an application for engagement with ac.care.

2.1 Medical and/or Disability

The following question is designed to assist in ensuring you are fit to perform the duties of the placement role you have applied for; in ascertaining if any reasonable workplace adjustments are required in order for you to perform the inherent requirements of the role; and to assist ac.care and responsible officers in meeting obligations under the Work Health and Safety Act 2012. ac.care embraces diversity and inclusion and will undertake all reasonable efforts to accommodate you.

This question is also important to assist ac.care to implement workplace diversity initiatives.

Do you currently have any medical condition or disability (including learning disability) which might prevent or impede you from being able to satisfactorily perform any duties or functions that might be reasonably required of you in the role for which you have applied?	Yes No Unsure
Please give further information if ‘yes’ has been ticked:

Please Note:

If yes or unsure, please provide details (include details of any medications/ assistance/adjustments that may reasonably be required so that you can perform the inherent requirements of the role).

You may be required to participate in a medical and/or functional capacity assessment (at your own cost) in order to assist in assessing your suitability to be offered employment with ac.care. If you do not agree to participate, you will not be further considered to receive an offer of employment.

2.2 Criminal History

In assessing whether it is appropriate to offer you a placement in ac.care, it is important to consider your suitability to adhere with these ethical obligations, your character, and prior conduct. At ac.care we welcome applications from people with lived experience. We may however wish to discuss further with you your current situation. The following questions are important to help assess your suitability to be offered employment with ac.care.

Have you ever been investigated or found guilty of any criminal offence excluding spent convictions in accordance with the Spent Convictions Act 2009, including any traffic offences not resolved by expiation?	Yes No
Have you ever been the subject of allegations of conduct by you towards a child (Person under 18 years of age) that if proven would have amounted to criminal conduct or would have constituted misconduct in an employment setting?	Yes No
Are you currently facing criminal charges yet to be finalised?	Yes No
Have you ever been convicted for driving under the influence of alcohol, drugs or had a licence cancelled or suspended in the last 5 years?	Yes No
Please give further information if ‘yes’ has been ticked:

Please note:

In addition to this declaration, you may be asked to agree to Criminal History or other background history screening or assessment. You will not be further considered for an offer of employment with ac.care if you do not agree to participate in such history or other background screening or assessment.

If you are offered and accept employment with ac.care, it will be a condition of such employment that you agree to periodic history or background screening or assessment.

2.3 Employment History

The following questions are designed to assist in assessing your suitability to complete placement with ac.care with regard to the significant ethical obligations. At ac.care we understand that there may be circumstances in your past that are not reflective of your current situation.

Has your employment been terminated by any organisation, for any reason?	Yes No
Have you been the subject of allegations or an investigation or any other process relating to alleged unsatisfactory performance or misconduct by you as an employee?	Yes No
Are you currently, the subject of an investigation or any other process relating to suspected or alleged misconduct or other unsatisfactory performance by you?	Yes No
Please give further information if ‘yes’ has been ticked:

2.4 Insurance

Have you ever had motor vehicle insurance declined/cancelled/conditions imposed in the last 5 years?	Yes No
Please give further information if ‘yes’ has been ticked:

2.5 Redemption of Workers Compensation Entitlements

Have you resigned from any employment upon the redemption of workers compensation entitlements?	Yes No
Commencement date of agreement: Click or tap to enter a date.

SECTION 3: Declaration

I [name] declare that the information in this declaration and in any other documents completed by me and/or any other statement made by me in support of my application for placement with ac.care, and the information provided by me in connection with my application for placement with ac.care including in any interview, is true and correct in every detail.

I understand that any false statement made in connection with my application for placement with ac.care - which will include information withheld or incomplete - may lead to a rejection of my application for placement, or, in the event that I am successful in my placement or continue my placement with ac.care, will amount to misconduct and render me liable to disciplinary action, including termination of my placement.	Yes No

Click or tap to enter a date.
Electronic Signature	Electronic Date

Approval - ac.care to complete

Application has been	Accepted	Not Accepted

Student Name:
Placement position:
Program:
Site:
FTE/hrs per fortnight	FTE: Hrs: Mon Tue Wed Thu Fri
Reports to:
Duration of placement:	Start date: Click or tap to enter a date. End Date: Click or tap to enter a date.
Interviewed by:
Referee check completed by:
Click or tap to enter a date.
First Line/General Manager (Name)	Position	Date
Click or tap to enter a date.
Manager HR (Name)	Position	Date