Are you currently employed in the Australian Yes No Public Service? If are you an ongoing employee? Yes No ‘Yes’, Current classification: Current department/agency: If state your current employer: ‘No’, Have you received a redundancy benefit from an Yes No APS agency or non-APS government employer in the last 12 months? Can we contact you at work? Yes No Workplace Are you (please tick): of Aboriginal origin? of Torres Strait Islander origin? a person with disabilities? a person from a non-English speaking background? Do you require any special assistance to participate in further assessment of your application? If yes, please provide details. Referees Referee 1 Referee 2 Name: Name: Employer: Employer: Briefly describe your relationship (e.g. supervisor, Briefly describe your relationship (e.g. supervisor, personal): personal): Phone number: number: Applicant’s statement I certify that the information provided in this and any supporting documents I provide are true and complete. I understand and agree that a false statement may preclude me from further consideration or, in the event that I am the successful applicant, may result in the termination of my employment. Signature: Date:
Are you currently employed in the Australian Public Service? Yes No If ‘Yes’, are you an ongoing employee? Yes No Current classification: Current department/agency: If ‘No’, state your current employer: Have you received a redundancy benefit from an APS agency or non-APS government employer in the last 12 months? Yes No Can we contact you at work? Yes No Workplace Are you (please tick): of Aboriginal origin? of Torres Strait Islander origin? a person with disabilities? a person from a non-English speaking background? Do you require any special assistance to participate in further assessment of your application? If yes, please provide details. Referees Referee 1 Referee 2 Name: Name: Employer: Employer: Briefly describe your relationship (e.g. supervisor, personal): Briefly describe your relationship (e.g. supervisor, personal): Phone number: number: Applicant’s statement I certify that the information provided in this and any supporting documents I provide are true and complete. I understand and agree that a false statement may preclude me from further consideration or, in the event that I am the successful applicant, may result in the termination of my employment. Signature: Date: