Samaritans Employment Application Form

Please ensure you refer to the "Information for Applicants" brochure for assistance prior to submitting your application as it details what we will be looking for.

Fields in Blue are required

Position Name :
Reference Number :
Closing Date :
Personal Details
Name :
Address :
Suburb :
Postcode :
Email Address : (or enter "Do not have")
Phone Work :
Phone Home :
Phone Mobile :

Employment Referees:
Please include details of at least two work-related referees, one of whom must have supervised you in the last 12 months. Please ensure your referees are happy to provide a verbal reference on your work performance and that you have a current contact number for them.

For each referee please include Name, Title, Company and Phone number/s
Referee # 1
Referee # 2
Referee # 3
Referee # 4

Do you give Samartitans permission to contact the above nominated referees for a verbal reference	Yes No

Do you hold a current driver's licence?	Yes No
If Yes, what class?

Are you a prohibited person under the NSW Child Protection (Prohibited Employment) Act 1998?	Yes No

Do you consent to a "Working with children" Police check being done prior to appointment?	Yes No

Have you read and understood Samaritans Mission, Vision and Values?	Yes No

Do you agree to work within Samaritans Mission, Vision and Values?	Yes No

After reading the Information for Applicants brochure and Position Description for the role you are applying for, do you have any injuries, illnesses or conditions which would prevent or impinge on your ability to undertake the inherent requirements of the position?	Yes No

How did you first find out about this position?

Attach your Resume
Attach your Covering letter
Attach your Statement Addressing Criteria (if requested for this position)
Each attachment should be no larger than 1Mb (1000k) each
	form rev 2.5

Thank you for your interest in working with the Samaritans Foundation

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