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 Non-binary / Non-conforming Prefer not to say

1. LinkedIn URL

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

1. Are you a current or previous Juniper employee?*

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

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

   1. Yes
   2. No
7. If yes, please explain:
8. 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
9. If other illness, please explain:
10. Please comment on any options you have ticked above:
11. 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
12. Please comment on any options you have ticked above:
13. 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
14. To the best of your knowledge and belief, are you of sound health?*

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

    1. Yes
    2. No
17. 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
18. Do you have any charges pending before any court?*

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

    1. Yes
    2. No
20. 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
21. I consent to Juniper retaining the personal information I have provided in my application.*

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

    1. Yes
    2. No
23. If yes, please provide the full name of the Juniper employee that referred you:
24. 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
25. If employed in this role I will adhere to Juniper's values of welcome, respect, compassion and hope.*

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

    1. Yes
    2. No
27. 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