Employment Application Form

Apply for a job at Wurli-Wurlinjang

Position Details
Position Applying For*
Source of Advertisement (e.g. newspaper, Internet, staff vacancy notice)
Applicant Details
Title*
- Dr
- Mr
- Mrs
- Ms
- Miss
Family Name*
Given Name*
Postal Address
Home Phone
Work Phone
Mobile
Email*
Enter Email Confirm Email
Country of Birth*
Do you have a current Driver's Licence?
- Yes
- No
If yes, please provide your licence number
If yes, is your licence issued in the Northern Territory?
- Yes
- No
AHPRA Registration Number (Clinical positions only)
Citizenship (please indicate which category applies to you)*
- Australian Citizen
- Permanent Resident
- Temporary Resident
Are you of Aboriginal and/or Torres Strait Islander origin?*
- No
- Aboriginal
- Torres Strait Islander
- Aboriginal and Torres Strait Islander
Referees
Referee One*
Name Organisation Contact Number Email
Referee Two*
Name Organisation Contact Number Email
Medical Information
Do you have any health problems or a medical condition that may affect your ability to perform the requirements of the position as outlined in the position profile provided that is relevant to the position applied for?*
- Yes
- No
If yes, please provide the details:
UPLOAD YOUR COVER LETTER AND RESUME. PLEASE ALSO INCLUDE ANY RELEVANT SUPPORTING DOCUMENTS SUCH AS YOUR RELEVANT QUALIFICATIONS/OCHRE CARD ETC*
Drop files here or

Accepted file types: doc, docx, pdf, jpg, Max. file size: 20 MB, Max. files: 3.
Please provide a cover letter that outlines your suitability for the role
Application Requirements
To be considered for selection and interview, please ensure your application demonstrates your suitability for the role as per the competencies in the position profile.
In your application, please confirm you have:*
- Cover letter outlining your suitability for the role
- Attached current Résumé
- Nominated two referees
- Current National Police Certificate (not less than 3 months old from date of issue)
Your Consent
By submitting this form I consent to Wurli Wurlinjang Health Service seeking verbal or written information on a confidential basis about from previous employers and the referees nominated on my Résumé and authorise the information sought to be released by them to the organisation for the purposes of ascertaining my suitability for the position for which I am applying.
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Name	Organisation	Contact Number	Email

Name	Organisation	Contact Number	Email

Employment Application Form

Apply for a job at Wurli-Wurlinjang

Position Details

Applicant Details

Referees

Medical Information

Application Requirements

Your Consent