Application form for Occupational Therapist Date Title Mr Mrs Miss Ms Other Do you identify as Aboriginal/Torres Strait Islander? YES NO First Name Surname Date of Birth Place of birth State/Country Do you require a Visa to work in Australia? YES NO Email Address Home Address Home Ph Suburb State Postcode Qualifications Please advise your qualifications and upload certificates where possible Certificate Diploma Trade Degree Qualifications Browse Health and Safety / Medical Questionnarie Please answer the following questions and provide details where applicable. Have you ever had any injuries that impacted on your ability to perform work? YES NO Resume Browse Browse PRIVACY & PERSONAL INFORMATION CONSENT Please complete the following consent statement I, consent to the collection of necessary personal information, including age, gender, medical history / reports, address details for the purpose of recruitment for this position.I agree to undertake all medical tests and examinations as required to ensure my capability to perform the tasks required of the position for which I have applied. I hereby declare that the information I have provided in this form is true and accurate and I authorise the company to verify any information if required. Any false or misleading information may result in the termination of my position / application.I have read and understood my rights in respect of access to and collection of my personal information.