Somerville is collecting personal information from you as part of the recruitment and selection process. We recognise the importance of privacy and we are committed to ensuring the privacy of your personal information collected and/or received by us. Our recruitment applications are hosted by external service providers who also recognise the importance of privacy.

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. Do you have a Tertiary qualifications in Disability Studies, Community Services, or related field (minimum of Certificate IV)?*

   1. Yes
   2. No
2. How many years experience do you have working with those in Independent Living?*

   1. Less than one year
   2. 1-3 years
   3. More than 3 years
3. How many years experience do you have working with people with disabilities?*

   1. Greater than 3 years
   2. Greater than 1 year
   3. No experience
4. Do you have a comprehensive understanding of the National Disability Insurance Scheme (NDIS)?*

   1. Yes
   2. No
5. Do you have the right to work in Australia? *

   1. Australian Citizen
   2. Australian Permanent Resident
   3. New Zealand Citizen
   4. Family/partner visa with no restrictions
   5. Graduate temporary work visa
   6. Holiday temporary work visa
   7. Temporary visa with restrictions on work locations (e.g. skilled regional visa 489)
   8. Temporary protection or safe haven enterprise work visa
   9. Temporary visa with no restrictions (e.g. doctoral student)
   10. Temporary visa with restrictions on work hours (e.g. student visa or retirement visa)
   11. Require sponsorship to work for a new employer (e.g. 482, 457)
6. Do you currently live in the Northern Territory? *

   1. Yes
   2. No
7. Do you have a full Australian Driver's license that is free from restrictions of any kind?*

   1. Yes
   2. No
   3. No driver's license
   4. Oversees driver's license
8. Do have experience with not for profit organisations?*

   1. Yes
   2. No
9. Do you hold a current Working with Children Card or have applied for one and are waiting for an outcome? *

   1. Yes
   2. No
10. Do you hold current First Aid Certificate?*

    1. Yes
    2. No
11. Do you have a current CPR certificate?*

    1. Yes
    2. No
12. Do you have an NDIS Worker Screening Check?*

    1. Yes
    2. No
13. Please provide referee details from your current employer. You need to provide referee NAME, TITLE, ORGANISATION, WORK EMAIL & WORK PHONE NUMBER. Your referee MUST be someone who has directly supervised you and can comment on your work performances. If you are currently not working than please provide reference from your most recent employer.*
14. Please provide your second referee details from your previous employer. You need to provide referee NAME, TITLE, ORGANISATION, WORK EMAIL & WORK PHONE NUMBER. Your referee MUST be someone who has directly supervised you and can comment on your work performances.*
15. Our organisation sets a high standard for equal employment opportunity. We encourage people of every age, culture, race, religion and physical ability to apply. Are you an Aboriginal or Torres Strait Islander wishing to apply for this role? * Yes - Both Aboriginal & Torres Strait Islander Yes - Aboriginal Yes - Torres Strait Islander No Do Not Wish To Disclose
16. I hereby confirm that all my responses to the above screening questions are true and correct. I understand that any false or misleading information, could lead to the withdrawal of my application, or an offer of employment, or after commencement of employment may constitute grounds for termination of employment summarily.*

    1. Yes
    2. No