Job Application

APPLICATION FOR EMPLOYMENT FORM

Liverpool Council is a totally smoke free workplace and is committed to the principles and practices which underpin Equal Employment Opportunity and Cultural Diversity policies.

POSITION DETAILS
*Position Title
*Position Reference No.
Closing Date

PERSONAL DETAILS
*Last/Family Name		*Title (Ms / Miss / Mrs / Mr / Dr )
*Given Names

*Address



	Postcode

Telephone:

Home

Work

Mobile

*Email Address

EDUCATION AND TRAINING

*Secondary School Education*
*School Attended	*Year Completed	*Final Year Achievement

*Tertiary Education*
Institution/s Attended	Year Completed	Final Year Achievement



*Other Relevant Training/Development*
Course/Seminar/Workshop	Year	Level of Attainment

*CURRENT EMPLOYMENT

Unemployed
Current Employer
Position Held
Date Commenced
Reason for Leaving

*SUMMARY OF EMPLOYMENT HISTORY

Please provide further details in your resume.

No employment history

*Employer*	*Position Held*	*Dates*	*Reason for Leaving*

OTHER SUPPORTING INFORMATION

EMPLOYMENT

Liverpool City Council is an Equal Opportunity employer. Appointment to Council is based on merit. Merit is determined through an assessment of an applicant’s skills, knowledge, abilities and potential against the selection criteria for the position, based on the written application, interview process and the feedback from referees.

In addition to completing the information above, please provide further details of your employment/work history including the title of each position, the name of employer, functions and responsibilities. These can be listed in your resume.

CLAIM FOR POSITION

Prior to applying for a position you will need to obtain a job information package from the council's contact centre on 1300 36 2170, or from Council’s web site at www.liverpool.nsw.gov.au. You must prepare a submission outlining your claim for the position.

In the submission, you must list each selection criteria for the position which are listed in the Job Description and Person Specification and address each of the criteria very clearly, stating how your skills, knowledge, experiences and qualifications enable you to meet them. This will enable the selection panel to form an accurate opinion of your eligibility for the position.

REFEREES

Please complete the following section nominating two referees who may be contacted about your application. One of the referees must be your current or most recent employer. If contacted, they will be asked to provide information on your past employment and work performance relevant to the selection criteria for the position. We will not contact your referee prior to interviews or without your prior verbal consent.

Your current/most recent manager/supervisor

A second work or educational referee

Name of Referee		Name of Referee
Position Held		Position Held
Employer		Employer
Phone No. (s)		Phone No. (s)

RESIDENTIAL STATUS

Employment with Council is subject to:

the applicant successfully passing a prescribed medical examination;
the applicant being an Australian Citizen or having the status of permanent resident of Australia (for permanent positions); and
the applicant’s eligibility to work in Australia.

*Residential Status (Please tick applicable box)*	*Yes*	No
*I am an Australian Citizen
*I am a Permanent Resident of Australia
*I am eligible to work in Australia

SOURCE OF JOB ADVERTISEMENT

Please indicate by ticking an appropriate box as to how you became aware of this vacant position.

Sydney Morning Herald	Liverpool Champion/Leader	Local Govt Jobs Directory	Council’s web site
Internet	Daily Telegraph	Employment Agency	Other (please specify)

Day the position was advertised (for Sydney Morning Herald and Daily Telegraph):

DECLARATION

*I declare that the information provided in this form and all supporting application documents for this position, including previous employment history and qualifications are complete, true and correct. I have also declared other matters that may be considered relevant to this application (for example, related criminal offences, or disciplinary action). If appointed, my failure to provide true, complete and correct information in relation to this position could lead to my dismissal from Liverpool City Council. In submitting this application electronically I acknowledge and agree to the above and if invited to interview I will be required to sign a copy of this form.

I agree

I disagree

APPLICATION CHECKLIST

You must attach the following files:		Yes	No
1.	*Your resume
2.	*Your claim for the position
3.	*EEO form (continued in this application form below)
Copies of transcripts, references, and academic records/certificates etc should not be forwarded.

Pick a file to upload:

Pick a file to upload:

Pick a file to upload:

Pick a file to upload:

Pick a file to upload:

THANK YOU FOR APPLYING

EQUAL EMPLOYMENT OPPORTUNITY

Liverpool City Council is an Equal Employment Opportunity employer. We are committed to maintaining EEO statistics and records as part of the recruitment and selection process. The information in this section of the application form is for Council’s record keeping purposes only. Your suitability for the vacant position will be judged solely on the selection criteria for the position, and will not be influenced by the information in the EEO section.

*Please select the appropriate box:*

SEX:	Male		Female
DATE OF BIRTH:
	D	D	M	M	Y	Y	Y	Y
MARITAL STATUS:	Married		Single
	Other

CULTURAL BACKGROUND:
Country of Birth:	Australia	Other
	If other, please specify
Are you of Aboriginal or Torres Strait Islander origin?	Yes	No
Country of Birth of Mother:	Australia	Other
	If other, please specify
Country of Birth of Father:	Australia	Other
	If other, please specify

LANGUAGE:
Do you speak a language other than English at home?	Yes	No
	If yes, what language
FAMILY:
Do you have any dependent children?	Yes	No
	If yes, how many are living at home?
Do you have the sole responsibility to care for any other family member (i.e. parents, partner)?	Yes	No
RELIGION:
What is your religion?
DISABILITY:
Do you consider yourself to have a disability?	Yes	No
	If yes, nature of disability