Screen Reader Mode Icon Check SCREEN READER MODE to make this survey compatible with screen readers. Disability Support Worker Status Update Question Title * 1. Title Mrs Mr Ms Miss OK Question Title * 2. Gender Male Female Other OK Question Title * 3. Name First Middle Surname OK Question Title * 4. Address Unit Number/ House Number Street Name Suburb State Postcode LGA ( Local Council) OK Question Title * 5. Contact Details Telephone - Landline Telephone - Mobile Email Address OK Question Title * 6. Transport Details Car Other (please specify) OK Question Title * 7. Are you fluent in a language other than English? (including Auslan) Yes No If yes, please specify OK Question Title * 8. Do you have previous experience with the following? In Home Care Residential Care Aged Care Other (please specify) OK Question Title * 9. Ideally, how many hours would you like to work per week? 0-5 5-10 10-15 15-20 20 + Client Specific OK Question Title * 10. Are you currently seeking extra shifts? Yes No OK Question Title * 11. I am currently seeking more shifts during the following times Morning (6am-11am) Lunch (11am-1pm) Afternoon (1pm-5pm) Dinner (5pm-7pm) Evening (7pm-10pm) Sleepover (10pm-6am) Monday Monday Morning (6am-11am) Monday Lunch (11am-1pm) Monday Afternoon (1pm-5pm) Monday Dinner (5pm-7pm) Monday Evening (7pm-10pm) Monday Sleepover (10pm-6am) Tuesday Tuesday Morning (6am-11am) Tuesday Lunch (11am-1pm) Tuesday Afternoon (1pm-5pm) Tuesday Dinner (5pm-7pm) Tuesday Evening (7pm-10pm) Tuesday Sleepover (10pm-6am) Wednesday Wednesday Morning (6am-11am) Wednesday Lunch (11am-1pm) Wednesday Afternoon (1pm-5pm) Wednesday Dinner (5pm-7pm) Wednesday Evening (7pm-10pm) Wednesday Sleepover (10pm-6am) Thursday Thursday Morning (6am-11am) Thursday Lunch (11am-1pm) Thursday Afternoon (1pm-5pm) Thursday Dinner (5pm-7pm) Thursday Evening (7pm-10pm) Thursday Sleepover (10pm-6am) Friday Friday Morning (6am-11am) Friday Lunch (11am-1pm) Friday Afternoon (1pm-5pm) Friday Dinner (5pm-7pm) Friday Evening (7pm-10pm) Friday Sleepover (10pm-6am) Saturday Saturday Morning (6am-11am) Saturday Lunch (11am-1pm) Saturday Afternoon (1pm-5pm) Saturday Dinner (5pm-7pm) Saturday Evening (7pm-10pm) Saturday Sleepover (10pm-6am) Sunday Sunday Morning (6am-11am) Sunday Lunch (11am-1pm) Sunday Afternoon (1pm-5pm) Sunday Dinner (5pm-7pm) Sunday Evening (7pm-10pm) Sunday Sleepover (10pm-6am) OK Question Title * 12. Do you work for another provider? Yes No If yes, please specify OK Question Title * 13. Work Rights Australian Citizen Permanent Resident Working Visa (please advise type) OK Question Title * 14. Do you possess a current Employment Police Check? Yes No Expiry Date: OK Question Title * 15. Do you possess a current Employee Working with Children Check? Yes No Expiry Date: OK Question Title * 16. Are you willing to undertake the following checks where applicable? Yes No Police Check Police Check Yes Police Check No Employee Working with Children Check Employee Working with Children Check Yes Employee Working with Children Check No Disability Worker Exclusion Scheme (DWES) Disability Worker Exclusion Scheme (DWES) Yes Disability Worker Exclusion Scheme (DWES) No Medical Medical Yes Medical No Ongoing Visa checks (as applicable) Ongoing Visa checks (as applicable) Yes Ongoing Visa checks (as applicable) No If answered no to any or all of the above, please explain why OK Question Title * 17. Qualification Level: Completed Year 10 or Below Completed Year 11 Completed Year 12 Certificate II Certificate III Certificate IV Certificate IV Nursing Diploma Nursing Bachelor of Nursing Other: OK Question Title * 18. Which of the following are you currently competent in? CPR First Aid Manual Handling Infection Control Fire Safety /Evacuation OHS Fundamentals Medication Management Food Safety OK Question Title * 19. How far are you willing to travel for short shifts? (1 hour minimum) 1 KM 3 KM 5 KM 10 + KM OK Question Title * 20. How far are you willing to travel for a long shifts? (more than 3 hours) 5 KM 10 KM 15 KM 20 + KM OK Question Title * 21. What are your work preferences? Showering Grooming Toileting / Leg Bags Exercise Programs Meal Preparation Peg Feeding Sleepovers Domestic Assistance Recreation Bowel Care OK Question Title * 22. Please select the consumer groups you have prior experience with Paraplegia Muscular Dystrophy Quadriplegia Multiple Sclerosis Cerebral Palsey Aged Care Epilepsy Non Verbal Clients Other (please specify) OK Question Title * 23. Please select below your working preferences Work with Males Work with Females Work with Children Work around a smoker Work around animals Languages Other (please specify) OK Question Title * 24. Which of the following equipment are you confident in operating? Hoists (Electrical) Hoists (Manual) Hoists (Ceiling) Slide Boards / Sheets Electric Wheelchair Manual Wheelchair Catheter Care /C'Dom Drainage Other OK Question Title * 25. Which of the following duties do you have experience with? Personal Care Bowel Care Leg bag/catheter care Peg Feed Showering/Dressing Meal Prep/assist Medication Assist Domestic Support Hoist transfers Wheelchair Community Access Therapy support OK DONE