Name: Guardian Nursing Agency
Address: 2274 Albany Highway, Gosnells, WA, 6110, AU
Telephone: 1300 133 633

Caring with Dignity & Compassion

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enquiry@guardiannursingagency.com

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Application Information

Please Read Before Filling Out

This application form is a critical part of the recruitment process. To ensure your application is processed smoothly, kindly complete all relevant fields with accurate information. This will help our HR team assess your suitability for the role and determine whether your application can proceed to the next stage. Some document fields include links and guidance to assist you in providing the correct information.

Important Notes :

Applications missing the required documents or attaching them to incorrect fields will not be considered for further assessment.
Only applicants with a minimum of 12 months of relevant experience in the industry will be considered for employment opportunities at GNA Services.

Thank you for your interest in joining our team.

Name *

Address *

Phone *

Email *

Are you of Aboriginal or Torres Strait Islander origin?

Yes, Aboriginal Yes, Torres Strait Islander

Rights to work in Australia *

Work History :

Please provide details of your previous work experience. This information will help us determine your classification and increment level in line with industry standards and GNA Services' policies. – content change.

Previous Employer 1

Company

Position

Key Duties

Job Type

Work Referees :

Referee 1

Name *

Phone

Referee 2

Name *

Phone

TRAINING AND CERTIFICATES

If Any of the Following Are Not Yet Completed Please attach evidence of your booking for any pending requirements.

First Aid Certificate and/or CPR (current) * * (File supported .docx, .pdf, .jpg, .png)

Manual Handling Certificate (current) * * (File supported .docx, .pdf, .jpg, .png)

NDIS Workers Orientation Certificate * * (File supported .docx, .pdf, .jpg, .png)

NDIS Worker Orientation Module – 'Quality, Safety and You' Click here to read

NDIS Workers Screening Check * (File supported .docx, .pdf, .jpg, .png)

Click here to read

Please note: This has hand hygiene included.

NDIS Worker Screening Check/Clearance - Please attach a copy if you currently hold this check.
Note : If you do not have the NDIS Worker Screening Check, GNA Services will provide you with their provider number upon successfully completing an interview. (This field can be left blank if you do not yet have the check.)

Hand Hygiene for Clinical Health Care Workers Untitled * * (File supported .docx, .pdf, .jpg, .png)

National Hand Hygiene Initiative (NHHI) Learning Management System (LMS).
Visit the link: https://nhhi.southrock.com/ to register (or log in if you already have an account). Once logged in, click on the Hand Hygiene Modules section. Select and complete the required module.

Personal Protective Equipment (PPE) Training * * (File supported .docx, .pdf, .jpg, .png)

Click here to read

Note: This takes only 15 minutes to complete.

PLEASE ATTACH THE FOLLOWING OF WHAT YOU ALSO HOLD

Working with Children Check
Medication Competency certificate
Peg Feed
APHRA Reg No.
Tracheostomy Care
Certificate III in Individual Support

CIV in Disability
Allied heath certificate
Diploma of Nursing (EN)
Degree in Nursing / Health Science (RN)
Other

Additional Medical Qualifications * (File supported .docx, .pdf, .jpg, .png)

What other languages do you speak other than English?

Identification

Primary ID *
Your Passport
Australian Citizenship Certificate
Birth Certificate

Primary ID * * (File supported .docx, .pdf, .jpg, .png)

Secondary ID *
Australian Drivers Licence
Medicare Card
Student Photo ID Card
Other

Secondary ID * * (File supported .docx, .pdf, .jpg, .png)

Travel

Current Drivers licence

Driver’s licence
* (File supported .docx, .pdf, .jpg, .png)

Do you have your own car and is it in good condition
Yes No

Do you have Comprehensive Car Insurance
Yes No

Car Insurance
* (File supported .docx, .pdf, .jpg, .png)

How far are you willing to travel? (Specify mins/kms)

NEXT OF KIN CONTACTS

Name

Relationship

Address

Phone

Emergency Contact (if different)

Name

Phone

WORKPLACE HEALTH & SAFETY

Have you ever had a workers' compensation claim? *
Yes No
If yes, please indicate the details (tick one or more): *
Lost time was paid
Payout of claim
Permanent Disability
If you answered yes to any of the above, can you provide a final clearance certificate? (A copy can be obtained from your medical practitioner or the insurer) * (File supported .docx, .pdf, .jpg, .png)
Have you taken more than 2 weeks of medical leave from work in the last 2 years?
Yes No
Are you currently taking any medications or supplements (prescribed, naturopathic, complementary, or illegal)?
Yes No
Do any of the medications listed above affect your alertness, cognitive responses, or physical ability to perform your duties safely?
Yes No
Are you allergic to anything?
Yes No
Do you have a history of musculoskeletal injuries?
Yes No

Vaccination and Screening History :

Have you received vaccination/screening for any of the following? (Please select Yes or No for each)

Adult Diphtheria and Tetanus (dTpa) within the last ten years:
Yes No

Pertussis (whooping cough)
Yes No

Hepatitis A
Yes No

Hepatitis B (with titre level > or = 10mlIU/mL)
Yes No

Tuberculosis
Yes No

Covid-19 Vaccination
Yes No

Measles/Mumps/Rubella
Yes No

Varicella (Chicken Pox)
Yes No

Influenza
Yes No

Do you have any physical or psychological limitations that would impact your ability to meet the requirements of your role?
Yes No

Medical Malpractice Insurance

In the past five (5) years, have you been the subject of any written disciplinary proceedings arising from professional misconduct in your role?
Yes No

Are you aware of any claims for malpractice being made against you or a previous employer arising from your actions?
Yes No

Are you aware of any claim or circumstance that might, in the future, give rise to a claim against you or a previous employer arising from your actions?
Yes No

If you answered ‘Yes’ to any of the above, please attach a separate sheet outlining the full circumstances of the matter being disclosed.
* (File supported .docx, .pdf, .jpg, .png)

Medical Malpractice Insurance

Cover Letter
* (File supported .docx, .pdf, .jpg, .png)

Please upload your CV *
* (File supported .docx, .pdf, .jpg, .png)

Declaration

I declare that, to the best of my knowledge, the information I have provided in this application for employment is true and correct.
I understand that providing incomplete, inaccurate, or misleading information, or knowingly withholding details, may result in the immediate termination of my employment.
I also acknowledge that completing this form does not constitute an offer of employment with GNA Services. Any potential offer of employment is subject to the successful completion of all relevant checks.

Caring with Dignity & Compassion

Services

NDIS & Disability
Aged Care
Community Service
Accommodation

Contact

enquiry@guardiannursingagency.com
1300 133 633

Guardian Nursing Agency acknowledges the Australian Aboriginal and Torres Strait Islander peoples of this nation. We acknowledge the traditional custodians of the lands on which our company is located and where we conduct our business. We pay our respects to ancestors and Elders, past, present and emerging.

Guardian Nursing Agency is committed to honouring Australian Aboriginal and Torres Strait Islander peoples are unique cultural and spiritual relationships to the land, waters and seas and their rich contribution to society.

Refer a Participant

enquiry@guardiannursingagency.com

Work With Us

Please Read Before Filling Out

Work History :

Work Referees :

Referee 1

Referee 2

TRAINING AND CERTIFICATES

Identification

Travel

NEXT OF KIN CONTACTS

WORKPLACE HEALTH & SAFETY

Vaccination and Screening History :

Have you received vaccination/screening for any of the following? (Please select Yes or No for each)

Medical Malpractice Insurance

Medical Malpractice Insurance

Declaration