Thank you for taking the time to complete this Application for Employment Form.

This form must be completed by each candidate. Applications from unsuccessful candidates will be destroyed by the Chairperson of the Interview Panel.

The information on this form will be treated as strictly confidential under the Privacy Act of 2000 and National Privacy Principles and will be used in connection with the prospective employment with this Health Service. The Health Service reserves the right to check detail; however, no approach will be made to your current employer without your permission.

All new employees are required to complete an application for employment form. There are a number of key questions on the form, which are explained as follows:


Before an official offer of employment is made, whether an internal or a new employee at least three reference checks must be made. The referees given by the individual must be recent, professional and ideally their current employer. If in doubt as to the nature of the referees, the applicant may be asked for clarification and additional referees if necessary.


We are committed to providing a safe work environment for all employees. It is our objective to ensure that employees are not required to work in duties that they are not able to perform safely.

Fields marked with an * are required

Application for Employment



Do you hold one of the following? (please specify)


Beechworth Health Service is committed to protecting the health, safety and well-being of all employees. To achieve this, the Health Service strives to ensure that employees are not required or permitted to undertake work for which they are not suited and to take appropriate measures to allow work to be done in a manner which will not put any person at risk to their health and safety.

Where you have a pre-existing injury and or disease, consideration will be given to reasonable modifications to the environment or tasks.

Do you agree to the following;

PRE-EXISTING INJURIES DECLARATION I acknowledge that I am required to disclose all pre-existing injuries and or diseases of which I am aware and could reasonably be expected to foresee and believe may affect my undertaking the job relating to this application for employment. Furthermore, if appointed I agree:

  • To abide by the By-Laws, Policies and Procedures of the Beechworth Health Service as determined by the Health Department and Board of Management.
  • To respect the absolute confidentiality of all patients, clients and personnel and I realise that breaches by myself could result in disciplinary action or dismissal action being taken.
  • I understand that I maybe required to work in any area under the jurisdiction of the Beechworth Health Service as negotiated within my contract.
  • To the best of my knowledge the information provided in this Declaration is true and correct.
  • The following declaration is made for the purposes of sections 41 of the Workplace Rehabilitation And Compensation Act 2013.


Confidentiality is a matter of concern for all persons who have access to personal information about patients or employees. Please refer to the Organisational Wide Policy – Policy 57-Privacy Policy. This policy is to be signed by all representatives of the Beechworth Health Service.

  • Is sensitive and is protected by law and by strict Health Service policies. The intent of these laws and policies is to assure that confidential information will remain confidential.
  • I will not in any way divulge, copy, release, sell, loan, alter or destroy any confidential information except as properly authorised by my manager or a delegated authority.
  • Enquiries about patients should be referred to the relevant manager.
  • Media enquiries – are to be directed to the CE or delegate.
  • I will access the patient information system only when my job requires me to do so. I will access only that part of the system that I require to do my job. When accessing the system I will use only my personal log on code. When leaving the computer I will lock the screen, preventing access to the computer unless via a personal log on code.
  • I agree to report suspected breaches of confidentiality immediately to my supervisor or Department Head.
  • I will use caution when conversing in public areas. In signing this declaration I agree to only collect and access confidential information that is necessary in the performance of my professional duties:


You must verify this submission before clicking on the send button by answering the following question.

This is a unique website which will require a more modern browser to work!

Please upgrade today!