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Last name:
Given Names:
Address 1:
Address 2:
City/Suburb:
State:
Postcode:
Phone Number:
Email:
Which Shifts do you have a preference to work?
 Dayshift (approximately 7am – 3pm) Afternoon Shift (approximately 3pm – 10pm) Night Shift (approximately 10pm – 7am)
Do you have a current police check or are you willing to allow Southern Cross Care (Broken Hill) to obtain a police check on your behalf?
 Yes No
Please indicate when you are available to start if you are successful?
 Immediately 1-2 weeks 2-3 weeks 3-4 weeks
Which of these locations are you interested in/available to work at
 St Anne’s Nursing Home Broken Hill Aruma Lodge Hostel Broken Hill Harold Williams Home Broken Hill Oasis Aged Care Irymple
Which of these roles are you potentially interested in applying for?
 Registered Nurse Enrolled Nurse Assistant In Nursing Care Service Employee Residents Activity Officer Administration Maintenance and Grounds Volunteer
How many years’ experience do you have in this or a similar role?
 None Less than a year 1 - 3 years 3 - 5 years 5 or more years
Experience: Where have you gained your Aged Care Experience? Please detail the size of the home (number or residents) as well as the type of care you provided.
Please list the qualifications you currently have.


Please tick the shifts/days you are available to work
 Monday Tuesday Wednesday Thursday Friday Saturday Sunday
 Day Shift Afternoon Shift Night Shift
How did you hear about Southern Cross Care Broken Hill?
 Southern Cross Care Website Seek.com.au Local Newspaper Word of Mouth Google Referral from a friend/current employee Other
Do you hold a qualification as a medication enrolled nurse?
 Yes No
To work as an Enrolled Nurse – Medication, registration with AHPRA is mandatory. Do you have current registration?
 Yes No
Do you have current knowledge of legislation, standards and guidelines in aged care?
 Yes No
Cover letter upload:
Please upload a cover letter (word or pdf):

Resume upload:
Please upload a copy of your resume (word or pdf):