Converge International Pty Limited ABN 12 113 688 627 (Converge International, we or our) is engaged by the Triple Zero Victoria (000VIC) to provide call taker recruitment screening services.  In connection with the services, we may collect and handle your personal information, which may include sensitive information and health information about you.  The Privacy Statement and Consent below sets out how we collect and handle your information and seeks your consent to our use of that information for the purposes specified.  Before submitting this application you should read and make sure you understand the Privacy Statement and Consent set out below.

We and Triple Zero Victoria are both committed to the protection of an applicant's privacy and personal information.  It is our aim to provide an environment in which personal information is managed in a secure, efficient and confidential manner.

We will collect and handle the information you disclose on this employment application as specified below and, unless stated otherwise, in accordance with our Privacy Policy. When we refer to information disclosed by you this may include your personal information, sensitive information and/or health information.  if there is any inconsistency between a provision of this Privacy Statement and Consent and our Privacy Policy, the terms of this Privacy Statement and Consent will prevail.

How we handle your information

We will handle the information you disclose on this application form as follows: 

• we will disclose your information to Triple Zero Victoria in relation to your application for employment;
• we will use your information to provide Triple Zero Victoria with an analysis or report based on that information;
• we will use your information to process your employment application, to track an application history, and to improve our recruitment and selection processes (and those of Triple Zero Victoria) through periodical statistical analysis; 
• we may disclose your information to Victoria Police for the purposes of security vetting or as authorised or required by law; and
• we may also disclose your information to external providers so that they may perform services for us or on our behalf, including for the purpose of tracking applicants and conducting interviews and aptitude testing or psychometric testing where this is a condition of pre-employment for assessment purposes only.

Access to your information

You have a right to seek access to your own health information that we hold and to correct that information if it is inaccurate, incomplete, misleading or not up to date.  We may only refuse you access to your own health records in limited circumstances, for example where disclosure might threaten someone's safety.

Trans-border data flows

The section headed 'Overseas Disclosure' in our Privacy Policy does not apply to the information you disclose on this application form. 

We will not disclose or otherwise transfer your information to any person who is outside Victoria unless permitted by applicable privacy laws and privacy principles.  The circumstances in which the applicable privacy principles permit such disclosure or transfer include: 

• where we reasonably believe that the recipient is subject to a law, binding scheme or contract which is substantially similar to the applicable privacy principles; and
• if you have consented to the disclosure or transfer.

Your application for employment with Triple Zero Victoria will not be processed if part or all of the information requested on this Employment Application form is not provided.

Your consent

I have read and understood the foregoing privacy information and hereby consent to Converge International or its authorised agents or representatives collecting, using and disclosing the personal information (including health information and sensitive information) provided by me and contained herein for the purposes outlined above or other lawful purposes as authorised or required by law and I consent to Triple Zero Victoria accessing and using the details provided by me in relation to my application for employment.

1. Yes I agree to the privacy statement*

1. Title* Mr Mrs Ms Miss Dr Other
2. First name*
3. Last name*

1. E-mail*
2. Phone*

   Digits only or add + for international numbers

1. Street*
2. Street Cont.
3. City, Town or Suburb*
4. Postcode or Zipcode*
5. Country*Please choose... AFGHANISTAN ALBANIA ALGERIA AMERICAN SAMOA ANDORRA ANGOLA ANGUILLA ANTIGUA AND BARBUDA ARGENTINA ARMENIA ARUBA AUSTRALIA AUSTRIA AZERBAIJAN BAHAMAS BAHRAIN BANGLADESH BARBADOS BELARUS BELGIUM BELIZE BENIN BERMUDA BHUTAN BOLIVIA BOSNIA AND HERZEGOVINA BOTSWANA BRAZIL BRUNEI DARUSSALAM BULGARIA BURKINA FASO BURUNDI CAMBODIA CAMEROON CANADA CAPE VERDE CAYMAN ISLANDS CENTRAL AFRICAN REPUBLIC CHAD CHILE CHINA COLOMBIA COMOROS CONGO CONGO, THE DEMOCRATIC REPUBLIC OF THE COOK ISLANDS COSTA RICA COTE D'IVOIRE CROATIA CUBA CYPRUS CZECH REPUBLIC DENMARK DJIBOUTI DOMINICA DOMINICAN REPUBLIC ECUADOR EGYPT EL SALVADOR EQUATORIAL GUINEA ERITREA ESTONIA ETHIOPIA FALKLAND ISLANDS (MALVINAS) FAROE ISLANDS FIJI FINLAND FRANCE FRENCH GUIANA FRENCH POLYNESIA GABON GAMBIA GEORGIA GERMANY GHANA GIBRALTAR GREECE GREENLAND GRENADA GUADELOUPE GUAM GUATEMALA GUINEA GUINEA-BISSAU GUYANA HAITI HOLY SEE (VATICAN CITY STATE) HONDURAS HONG KONG HUNGARY ICELAND INDIA INDONESIA IRAN, ISLAMIC REPUBLIC OF IRAQ IRELAND ISRAEL ITALY JAMAICA JAPAN JORDAN KAZAKHSTAN KENYA KIRIBATI KOREA, DEMOCRATIC PEOPLE'S REPUBLIC OF KOREA, REPUBLIC OF KUWAIT KYRGYZSTAN LAO PEOPLE'S DEMOCRATIC REPUBLIC LATVIA LEBANON LESOTHO LIBERIA LIBYAN ARAB JAMAHIRIYA LIECHTENSTEIN LITHUANIA LUXEMBOURG MACAO MACEDONIA, THE FORMER YUGOSLAV REPUBLIC OF MADAGASCAR MALAWI MALAYSIA MALDIVES MALI MALTA MARSHALL ISLANDS MARTINIQUE MAURITANIA MAURITIUS MEXICO MICRONESIA, FEDERATED STATES OF MOLDOVA, REPUBLIC OF MONACO MONGOLIA MONTSERRAT MOROCCO MOZAMBIQUE MYANMAR NAMIBIA NAURU NEPAL NETHERLANDS NETHERLANDS ANTILLES NEW CALEDONIA NEW ZEALAND NICARAGUA NIGER NIGERIA NIUE NORFOLK ISLAND NORTHERN MARIANA ISLANDS NORWAY OMAN PAKISTAN PALAU PANAMA PAPUA NEW GUINEA PARAGUAY PERU PHILIPPINES PITCAIRN POLAND PORTUGAL PUERTO RICO QATAR REUNION ROMANIA RUSSIAN FEDERATION RWANDA SAINT HELENA SAINT KITTS AND NEVIS SAINT LUCIA SAINT PIERRE AND MIQUELON SAINT VINCENT AND THE GRENADINES SAMOA SAN MARINO SAO TOME AND PRINCIPE SAUDI ARABIA SENEGAL SEYCHELLES SIERRA LEONE SINGAPORE SLOVAKIA SLOVENIA SOLOMON ISLANDS SOMALIA SOUTH AFRICA SPAIN SRI LANKA SUDAN SURINAME SVALBARD AND JAN MAYEN SWAZILAND SWEDEN SWITZERLAND SYRIAN ARAB REPUBLIC TAIWAN, PROVINCE OF CHINA TAJIKISTAN TANZANIA, UNITED REPUBLIC OF THAILAND TOGO TOKELAU TONGA TRINIDAD AND TOBAGO TUNISIA TURKEY TURKMENISTAN TURKS AND CAICOS ISLANDS TUVALU UGANDA UKRAINE UNITED ARAB EMIRATES UNITED KINGDOM UNITED STATES URUGUAY UZBEKISTAN VANUATU VENEZUELA VIET NAM VIRGIN ISLANDS, BRITISH VIRGIN ISLANDS, U.S. WALLIS AND FUTUNA WESTERN SAHARA YEMEN ZAMBIA ZIMBABWE INTERNATIONAL OTHER Unknown
6. State, Region or Province*Please choose...

1. LinkedIn URL

   (Please click on your profile and copy the URL from your profile page.)

1. Please select which Title best represents you?*

   1. Miss
   2. Mr
   3. Mrs
   4. Ms
   5. Mx
2. Are you 18 years of age or older?*

   1. Yes
   2. No
3. What is your citizenship status?*

   1. Australian citizen
   2. Australian resident
   3. New Zealand citizen
   4. Other (Please Specify Below)
4. If Other, please specify:
5. Have you previously applied for a Triple Zero Call-Taker position with ESTA within the past 12 months?*

   1. yes
   2. No
6. Are you, or have you ever been employed by ESTA?*

   1. Never Employed
   2. Previous Employee
   3. Current Employee
7. If you are a previous employee, please provide details of your Reporting Manager, the tenure of your position and the Position Title:
8. Preferences - Location & Agency Preference 1:* Ballarat - Ambulance Ballarat - Police/SES Ballarat - Fire Burwood East - Ambulance Burwood East - Police/SES Burwood East - Fire Williams Landing - Police/SES
9. Preferences - Location & Agency Preference 2: Ballarat - Ambulance Ballarat - Police/SES Ballarat - Fire Burwood East - Ambulance Burwood East - Police/SES Burwood East - Fire Williams Landing - Police/SES
10. Preferences - Location & Agency Preference 3: Ballarat - Ambulance Ballarat - Police/SES Ballarat - Fire Burwood East - Ambulance Burwood East - Police/SES Burwood East - Fire Williams Landing - Police/SES
11. Please indicate whether you are interested in working with ESTA on a Full-Time Roster or Part-Time Roster. *

    1. Full-Time Roster
    2. Part-Time Roster
12. Prior Victoria Public Sector Employment
    Victorian Public Sector Workplace Relations policy provides that applicants with previous Victorian Public Sector employment and who have received payment of a Voluntary Redundancy Package on retrenchment are ineligible to be employed within the Victorian Public sector for a period of 3 years from the date of retrenchment.
    If you have previously been employed in the Victorian Public Sector can you please answer the following questions and read and sign the declaration.
    
    Are you currently employed in the Victorian Public Sector?*

    1. Yes
    2. No
13. If yes, what is the name of the Department/Authority?
14. Have you received a Voluntary Departure Package from a Victorian Government/Authority in the last three years?*

    1. Yes
    2. No
15. If yes, please provide the separation date:
16. If yes, please provide the name of the Department/Authority:
17. I declare that the prior Victorian Public Sector employment details provided in this section are true and correct and acknowledge that if the details are found to be otherwise either prior to or, if successful with my application for employment, after commencing employment I will be deemed ineligible for employment or have my employment terminated, as applicable.*

    1. Yes
18. Education and Qualification
    What is the highest level of formal education you have completed?* Year 10 or below Secondary Education Certificate Certificate II Certificate III Certificate IV Certificate V Advanced Certificate Diploma Advanced Diploma Associate Diploma Bachelor Degree Bachelor (Hons) Masters Doctorate Post Grad Certificate Post Grad Diploma Member Prof Association Other Prefer not to respond
19. If Other, please specify:
20. In which of the following fields is this qualification? * Accounting Administration Agriculture/Primary Industry Arts and Sport Asset Management and Planning Communications, Marketing and Media Community Services Construction Consulting and Strategy Early Childhood Economics Education and Training Emergency Management Engineering Environment Finance Health and Allied Health Hospitality and Tourism Human Resources Information Technology Information Management Legal Medical and Nursing Natural Resources Management Planning Policy Property Research Business Development Science Trades and Services Transport and Logistics Other Prefer not to respond
21. If Other, please specify:
22. When did you complete this qualification? *
23. ESTA receives over 2,000 applications a year. Here is your chance to tell us why you want to become a call-taker and what makes you stand out? What skills do you have which will make you a great call-taker for the Victorian community. Please limit this to 200 words and try to maximize this as much as possible. This is your opportunity to make a great first impression. *
24. Pre-Existing Injury/Disease Declaration
    ESTA is committed to protecting the health, safety and well-being of all its people. ESTA strives to ensure that people do not undertake work for which they are not suited to and to take appropriate measures to allow work to be done in a manner which will not put themselves or any other person at risk. Initially, we request that you consider the key requirements of the role and let us know about any previous, pre-existing injuries or conditions that you are aware of. You will also be required to undertake a pre-employment medical assessment and drug and alcohol testing if you progress through the recruitment process.
    
    ESTA has a reasonable adjustment policy so where you have a pre-existing injury, illness and/or condition consideration will be given to reasonable modifications to the environment or tasks. You are required to disclose to Emergency Services Telecommunications Authority (ESTA) any previous or pre-existing injuries or conditions of which you are aware. This includes conditions that might affect or be affected by your proposed employment. If you fail to make such a disclosure or make a false or misleading disclosure then section 41(2) of the Workplace Injury Rehabilitation and Compensation Act 2013 (“the Act”) will apply. The effect of this sub-section is that you will not be entitled to compensation under the Act for any recurrence, aggravation, acceleration, exacerbation or deterioration of the pre-existing injury, illness or disease arising out of or in the course of, or due to the nature of, or due to your employment with the Emergency Services Telecommunications Authority (ESTA).
    
    Where you have a pre-existing injury, illness, disease and/or condition consideration will be given to reasonable modifications to the environment or tasks.
    
    I acknowledge that I am required to disclose all pre-existing injuries, illnesses, diseases or conditions which I am aware of and could reasonably be expected to foresee could be affected by my undertaking the job of Call-taker*

    1. Yes
25. AND (agree to the applicable statement below)*

    1. I do not believe that any pre-existing injuries, illnesses, diseases or conditions I have are likely to recur or deteriorate, accelerate or be exacerbated or aggravated by the key activities required to be undertaken which impact on health and safety.
    2. I declare the following pre-existing injuries, illnesses, diseases or conditions that may recur or deteriorate, accelerate or be exacerbated or aggravated by the duties required by the role of Call-taker.
26. Please list injuries and/or diseases as applicable:
27. I acknowledge that any non-disclosure or false or misleading information on my part may result in section 41 of the Workplace Injury Rehabilitation & Compensation Act 2013 being applied. This would disentitle my dependents or me from receiving benefits relating to any recurrence, aggravation, acceleration, exacerbation or deterioration of any pre-existing injury or disease, which I may have. To the best of my knowledge the information provided in this declaration is true and correct.*

    1. Yes
28. Diversity. ESTA is committed to building a diverse workforce that leverages and values diversity across gender, age, culture, disability and lifestyle. Completion of the following diversity-related questions is optional, and the information will only be used to report on the diversity of our candidate base.

    1. Female
    2. Male
    3. Self describe
29. If self describe, please specify:
30. Age: Under 20 years 20-29 years 30-39 years 40-49 years 50-59 years 60+ years
31. Are you an Aboriginal or Torres Strait Islander? Aboriginal Aboriginal & Torres Strait Islander Torres Strait Islander No
32. Are you from a non English speaking background?

    1. Yes
    2. No
33. Police Check
    As part of the recruitment process you are required to fill out and submit the attached Police Check form.
    Please click here to download the form and attach it as part of your application on the next page. Please note, while we acknowledge you may also have other valid Police Documents, we request that you complete and attach the above specified document regardless. Alternate documents will not be accepted. *

    1. I will complete and upload the above document (I understand that alternate documents will NOT be accepted)
34. Please confirm if you HAVE been involved in any of the above documents listed Police Matters?*

    1. I do have Police Matters to declare
    2. I do not have Police Matters to declare
35. Where did you first hear about the current Call-taker opportunities with ESTA?* SMOOTH FM 91.5 TRIPLE M FOX FM KIIS 101.1 GOLD 104.3 3AW JOY FM 3KND (Indigenous) NOVA 100 Power 103.1FM K ROCK Facebook Instagram LinkedIn Twitter YouTube Digital Streaming Spotify Google Seek Ballarat Courier Ballarat Times News Group Beaufort Pyrenees Advocate The Local (Daylesford) Maryborough Advertiser Geelong Independent Geelong Advertiser ESTA Website Referral by an ESTA Employee Disability Works Australia Employment Agency Government Career's Website News Article/Story University Job Board Monash University Referral Federation University Referral Other (Please Specify Below)
36. Where possible, please provide further information about how you heard about the Call-Taker position?