City of Swan

Administration Centre: 2 Midland Square, Midland, Western Australia

Correspondence: PO Box 196, Midland, Western Australia 6936

Administration Telephone: (08) 9267 9000 Facsimile: (08) 9267 9165

Customer Services Telephone: (08) 9267 9267
E-mail: hr@swan.wa.gov.au
Website: www.cityofswan.com

APPLICATION FOR ADVERTISED VACANCY

The City of Swan is an Equal Opportunity Employer

Vacant Position Information

Name of position applying for: _____________________________________________

Position number: _______________________________________________________

Personal Information

Surname: _________________________________________________________

Given names: _________________________________________________________

Postal address: ________________________________________________________

Suburb: ___________________________________ Postcode: _____________

Contact number (during working hours): _____________________________________

Date of birth (optional): ______ / ______ / ______

Do you have Permanent Resident Status? Yes

No

If no, do you have a current Work Visa? Yes

No

Do you have a current WA driver’s licence? Yes

No

If yes, please provide the following information:

Licence number: _______________________ Classes: _______________________

Expiry Date: ______ / ______

Referees

Please supply information about two professional referees who have supervised your
past work and can comment on your relevant skills and experience for the position
applied.

1. Name: ____________________________________________________________

Company: _________________________________________________________

Position: _________________________________________________________

Working relationship to you (eg Supervisor): _______________________________

Contact number (during normal business hours): ___________________________

2. Name: ____________________________________________________________

Company: _________________________________________________________

Position: _________________________________________________________

Working relationship to you: ___________________________________________

Contact number (during normal business hours): ___________________________

Supplementary details

Health
To the best of your knowledge and belief are you of sound health? Yes
No

If no, please provide details: ______________________________________________

______________________________________________________________________
______________________________________________________________________

* Applicants who perceive they have a health condition are invited to discuss its
relevance or otherwise to their prospects for employment with the interviewing
officer(s).

It is the City of Swan’s policy that prospective employees attend a pre-employment

medical examination to ensure fitness to undertake the position applied for. This is
undertaken at the City’s expense.
Disability
*A disability or injury is not a barrier when considering applications for employment.

To assist in assessing opportunities for your placement in appropriate employment,

please indicate whether you have a disability or injury that is likely to affect your work
performance, or which could recur or be aggravated by the type of work for which you
are applying:

Yes
No

If yes, please provide details: ______________________________________________

______________________________________________________________________
______________________________________________________________________

Convictions

Do you have any current convictions for any offences from any court; or are you
currently the subject of any charge pending before any court?

Yes
No

If yes, please provide details: ______________________________________________

______________________________________________________________________
______________________________________________________________________

*A criminal record does not necessarily disqualify an applicant. If rejection of your

application is considered solely because of a criminal record, you will be given the
opportunity to discuss the matter fully before a final decision is made. You do not
need to give details of any conviction which you have had declared spent (Spent
Convictions Act 1988).

I declare the above statements to be true in all aspects. I acknowledge that any
statement, which is found to be false or deliberately misleading, will make me, if
employed, liable for dismissal.

Signed: _______________________________________________________________

Date: ______ / ______ / ______