Juniper's recruitment applications are hosted by external service providers who also recognise the importance of privacy. By proceeding with your application, you acknowledge that your personal information will be hosted by these external service providers until such time as you elect not to have your information stored on these external hosted sites.

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. Gender Male Female Unspecified

1. Are you an Australian/New Zealand Citizen or Permanent Resident?*

   1. Yes
   2. No
2. Please provide the original of one of the following documents to be copied and sited when attending an interview. Please select which document you will attach to your application:* Passport Australian Birth Certificate Australian Citizenship Certificate
3. Are you a current or previous Juniper employee?*

   1. Yes
   2. No
4. Have you completed any qualifications?*

   1. Yes
   2. No
5. If Yes, please provide details:
6. Are you currently enrolled in a course of study?*

   1. Yes
   2. No
7. If Yes, please provide details:
8. Referee Details
   Referee 1 Full Name:
9. Organisation:
10. Position Title:
11. Business Phone:
12. Mobile Phone:
13. Email Address:
14. Relationship to Referee:
15. Referee 2 Full Name:
16. Organisation:
17. Position Title:
18. Business Phone:
19. Mobile Phone:
20. Email Address:
21. Relationship to Referee:
22. Equal Employment Opportunity
    Completion of this section is voluntary, however, your cooperation would be appreciated. This section is for compliance with EEO legislation only.
    
    Do you speak a language other than English?

    1. Yes
    2. No
23. If Yes, what other languages do you speak?
24. Juniper encourages applications from people of Australian Aboriginal and Torres Strait Islander origin.
    
    Are you of Aboriginal origin?

    1. Yes
    2. No
25. Are you of Torres Strait Islander origin?

    1. Yes
    2. No
26. It is the policy of Juniper to welcome applications from people with disabilities and attempt to meet reasonable/appropriate work-related requirements of employees.
    
    Do you have a disability?

    1. Yes
    2. No
27. Pre-Employment Health Questionnaire
    Are you being treated by any doctor for illness or injury (work related or otherwise) or have you required time off work in the last 12 months?*

    1. Yes
    2. No
28. If yes, please explain:
29. Are you taking any medications for a medical condition? *

    1. Yes
    2. No
30. If yes, please explain:
31. Do you have, or have you ever had, back, neck or shoulder problems?*

    1. Yes
    2. No
32. If yes, please explain:
33. Please tick any conditions that you have currently or that you have had at any time in your life:*

    1. Alcohol/Drug problems
    2. Allergies
    3. Arthritis/Rheumatism
    4. Bleeding/Blood Disorder
    5. Brain or nerve issue or disorder
    6. Carpel Tunnel Syndrome
    7. Depression/Anxiety or other psychological issue or disorder
    8. Diabetes
    9. Epilepsy
    10. Hernia
    11. High blood pressure or other heart or circulation problem
    12. Immune system issue or disorder
    13. Bone/muscle/joint issues or fractures
    14. Loss of Hearing
    15. Lung or respiratory issue
    16. Psychological Disorders
    17. Persistent headaches or migraines
    18. Tuberculosis
    19. Skin Disorders/Dermatitis
    20. Transmissible Disease (e.g. Hepatitis B)
    21. Repetitive Strain Injury/Overuse Injury
    22. Visual Impairment
    23. Other Illness (please list below)
    24. None of the above
34. If other illness, please explain:
35. Please comment on any options you have ticked above:
36. Important
    Disclosure of a medical condition or restriction will not automatically exclude an applicant from consideration for employment.
    
    Please tick any boxes for an activity with which you have difficulty. *

    1. Walking 100 Meters
    2. Standing for 2 hours
    3. Gripping firmly with both hands
    4. Hearing a normal conversation
    5. Crouching
    6. Lifting
    7. Bending
    8. Using hand tools
    9. Repetitive movements of hands or arms
    10. Kneeling
    11. Sitting for 2 hours
    12. None of the above
37. Please comment on any options you have ticked above:
38. Important Notice
    Please note that under Section 79 of the Worker’s Compensation and Rehabilitation Act, wilful and false representation regarding a previous disability may preclude the payment of future compensation.
    
    Declaration for Medical Questionnaire
    I declare that the answers to all questions are correct and that I have not withheld any information regarding my past or present health. I accept that if I am employed and it is subsequently found that I have wilfully misstated any significant information herein, I will be liable to dismissal. I give my permission to Juniper or a medical practitioner nominated by Juniper to seek and obtain any other relevant information from any available source which may be required to assess my past and present health status.*

    1. Yes
39. To the best of your knowledge and belief, are you of sound health?*

    1. Yes
    2. No
40. If no, please explain:
41. Are you willing to undergo a pre-employment medical assessment if required?*

    1. Yes
    2. No
42. Employment with Juniper is subject to the provision of a satisfactory Police Clearance as required under the Aged Care Act 1997. A criminal record does not necessarily disqualify an applicant. If rejection of your application is considered solely because of a criminal record, you will be given the opportunity to discuss the matter fully and confidentially with a senior member of staff before a decision is made.
    
    Do you have any convictions from any court?*

    1. Yes
    2. No
43. Do you have any charges pending before any court?*

    1. Yes
    2. No
44. Are you prepared to produce a Criminal Clearance certificate prior to accepting an offer of employment with Juniper?*

    1. Yes
    2. No
45. A previous Worker’s Compensation claim is not a barrier to the consideration of an application for employment with Juniper. This information assists us in assessing opportunities for your placement in appropriate employment.
    
    Have you ever made a claim for Worker's Compensation?*

    1. Yes
    2. No
46. Have you ever worked or been a patient in a hospital or a residential care facility outside of WA (including Christmas Island) during the past 12 months?*

    1. Yes
    2. No
47. I consent to Juniper retaining the personal information I have provided in my application.*

    1. Yes
    2. No
48. Did a Juniper employee encourage you to apply for this role?*

    1. Yes
    2. No
49. If yes, please provide the full name of the Juniper employee that referred you:
50. Have you ever been subject to any disciplinary action as a result of the abuse, neglect or mistreatment of care recipients or other serious misconduct in your previous employment?*

    1. Yes
    2. No
51. If employed in this role I will adhere to Juniper's values of welcome, respect, compassion and hope.*

    1. Yes
    2. No
52. Have you ever been employed by Juniper or Uniting Church Homes?*

    1. Yes
    2. No
53. I declare that the statements I have made and the information I have given are true to the best of my knowledge and belief. I have not withheld any relevant information required by this application, or made any false or misleading representations. I acknowledge that if I have knowingly or wilfully given false or misleading information or have withheld any information, it could result in:
    Rejection of my application
    Legal proceedings against me; or
    Dismissal after appointment
    
    I understand that appointment to Juniper is conditional upon production of proof of identity, proof of residency status and a current satisfactory national police clearance.*

    1. Yes