Are you of Aboriginal or Torres Strait Islander Descent:

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1 STAFF RECRUITMENT REGISTRATION PERSONAL PROFILE & SKILL AUDIT ASSESSMENT The information provided will be utilised solely for the purpose of Incompro Aboriginal Association s Recruitment and Training. PERSONAL DETAILS Are you of Aboriginal or Torres Strait Islander Descent: Family Name: Given Name(s): Preferred Name: Date of Birth: / / Address: Suburb: Postcode: Gender Male / Female Mobile Phone: Phone: Emergency Contact: Phone: Relationship to you: Do you have a disability What can you tell me about your disability? Has it stopped you from getting a job in the past? Do you have: DCSI Clearance (s) o Vulnerable Person o Disability Service Sector o Child Related Employment Child Safe Environments 100 point of ID Tax File Number Senior First Aid Certificate Manual Handling Certificate SA Drivers License

2 My current status is Unemployed Studying College / University Working Part-time Working Full-time Disability Pension Studying High School If Unemployed how long have you been unemployed? 6 months 12 months Longer than 12 months Other e.g. doing voluntary work, carer for a family member etc. (Please specify) I am seeking work within Tick the boxes that are appropriate for you: Indigenous Mentor Indigenous Youth Worker Client Services Officer Administration Officer Project Officer / Management Case Manager Volunteer I am seeking work Full Time Part Time Casual I would like assistance in the following Training Certificate 3 Individual Support Certificate 4 Youth Work First Aid Certificate Child Safe Environments Indigenous Mentoring Manual Handling Do you have a Job Active Provider Employment Service Provider: Telephone: Employment Consultants Name: Suburb: Jobseeker ID: Client Registration What type of benefit do you receive (if applicable):

3 Education, Skills and Experience What is your highest level of education completed: Year completed (e.g. year 10, 11 etc.) TAFE / College attended Years Courses Completed: University attended Years Other (please specify) Do you have a copy of your Certificates Have you had any other educational experiences or gained other qualifications that would be helpful for you to get a job?? First Aid Child Safe Environments Other Other (please specific) Do you have a Resume? (please provide a copy) Communication skills My communication skills are Poor Good Excellent If you have problems with communication, please tell us more about it (e.g. I find it hard to understand what people are saying). My reading skills are Poor Good Excellent My writing skills are Poor Good Excellent Please write a sentence putting Fishing, Football and Summer in it: My Math Skills are Poor Good Excellent My computer skills are Poor Good Excellent My listening skills are Poor Good Excellent

4 What else can you tell us about yourself? Punctuality I get to work, training & school on time I am an honest person I like to help other people I am a respectful student / employee and respect others I can follow instructions well I have good commitment to the goals I set I don t like conflict situations Transport Do you have your own vehicle? Do you have a current Drivers Licence? Car Light Truck/ Bus If your answer is NO, what has prevented you from getting one? Do you have access to public transport? Do you have other means of getting to and from work? (please tell us what they are) Accommodation Who do you live with? My own house Family Friends Other If Other, please tell us more Is your accommodation stable?

5 Family Do you have Children? Ages Do you need Child Care? Do you currently care for anyone else full time (i.e. family member, partner etc.) If Yes please tell us about the arrangements Will the care of your family members affect your ability to work (full time, part time) with Incompro? Please tell us more Health Do you have any health issues? Please tell us more about your health issues (ie diabetes, hearing problems, blood pressure)? Do you have prescribed medications for any of your health issues / illnesses? Are you a smoker? Do you have any other health issues or any previous or existing injury that may prevent you from doing some components of your work? (please tell us more) Authorisation By signing this Registration form, I certify that the information I have provided on this form is true and correct, and I authorise InComPro to utilise the information I have provided for the purposes of InComPro s Recruitment and Employment of staff. Participants full name: Participants signature: Date: / / If you are under 18years of age parent/guardian need to also sign this Authorisation. Parent / Guardian s full name: Parent / Guardian s Signature: Date: / /