sector, including (but not restricted to) my qualifications, experience, ability (such as eligibility to work i.e. appropriate visa status), physical or mental health or personal integrity, will make me liable to disciplinary action which may include dismissal. To the best of my knowledge all information contained in my application, provided in support of my application and disclosed in response to the following questions is true and correct in every respect. Do you currently have any disability or medical condition which might prevent or impede you from being able to satisfactorily perform any duties that might be required of you in the role for which you have applied? Yes Unsure No If yes or unsure, please provide details (please include details of any assistance or adjustments that would allow you to carry out the functions of the role). If you have any disability or medical condition which might require the provision of non standard measure to either provide you with a safe system of work, or to enable you to satisfactorily perform your duties, you should tell us. This information is necessary to enable us to provide a safe system of work to you in the event that you are offered employment, and to enable us to provide appropriate assistance. The provision of any such information will not be used to discriminate against you because of the existence of any such disability or medical condition. If you are offered the role, do you agree to undergo a medical examination that relates to the functions of the role? Yes No Have you ever been found guilty of an offence? Yes No If yes, please provide details: Are you currently facing charges yet to be determined for any offence?
sector, including (but not restricted to) my qualifications, experience, ability (such as eligibility to work i.e. appropriate visa status), physical or mental health or personal integrity, will make me liable to disciplinary action which may include dismissal. To the best of my knowledge all information contained in my application, provided in support of my application and disclosed in response to the following questions is true and correct in every respect. Do you currently have any disability or medical condition which might prevent or impede you from being able to satisfactorily perform any duties that might be required of you in the role for which you have applied? Yes Unsure No If yes or unsure, please provide details (please include details of any assistance or adjustments that would allow you to carry out the functions of the role). If you have any disability or medical condition which might require the provision of non standard measure to either provide you with a safe system of work, or to enable you to satisfactorily perform your duties, you should tell us. This information is necessary to enable us to provide a safe system of work to you in the event that you are offered employment, and to enable us to provide appropriate assistance. The provision of any such information will not be used to discriminate against you because of the existence of any such disability or medical condition. If you are offered the role, do you agree to undergo a medical examination that relates to the functions of the role? Yes No Have you ever been found guilty of an offence? Yes No If yes, please provide details: Are you currently facing charges yet to be determined for any offence?
ICAC%20employment%20declaration_1.docx