Pre-Employment Declaration

RECRUITMENT DECLARATION – APPLICATION FOR EMPLOYMENT WITH THE CITY OF MARION

Instructions to applicants:

To be eligible to receive an offer of employment within the City of Marion, you must complete a pre-employment declaration. You may also be required to agree to other pre-employment processes.

The information derived in this declaration and other pre-enrolment processes is necessary to assess the suitability of applicants to be offered employment in the City of Marion. It takes into account an applicant’s ability to perform the technical aspects of a role and the ethical obligations of a City of Marion employee. Some information is necessary to ensure the City of Marion and responsible officers of the City of Marion comply with their obligations under the Work Health and Safety Act 2012. Some information is necessary to ensure City of Marion meet workplace diversity targets.

The information is collected and will be managed in accordance Council’s Records and Information Management Policy, SA State Records Act 1997 and SA Local Government Act 1999.

You should be aware that the definition of misconduct, includes providing a false statement in connection with an application for engaging as a City of Marion employee.

You must answer all of the following questions fully and truthfully. Attach pages as necessary.

Full Name

Address

I am an applicant for the role of

MEDICAL AND/OR DISABILITY

The following question is designed to assist in ensuring you are fit to perform the duties of the role you have applied for; in ascertaining if any reasonable workplace adjustments are required in order for you to perform the inherent requirements of the role; and to assist the City of Marion in meeting obligations under the Work Health Safety Act 2012.

The question is also important as the City of Marion embraces Diversity and Inclusion in the workplace.

Do you currently have any disability (including learning disability) or medical condition which might prevent or impede you from being able to satisfactorily perform any duties or functions that might be reasonably required of you in the role for which you have applied?

Yes

No

Unsure

If yes or unsure, please provide details (include details of any assistance/adjustments that may reasonably be required so that you can perform the inherent requirements of the role)

Please note, you will be required to participate in a medical and/or functional capacity evaluation in order to assist in assessing your suitability to be offered employment in the role at the City of Marion. If you do not agree to participate, you will not be further considered to receive an offer of employment.

CRIMINAL HISTORY

City of Marion employees are under significant ethical obligations. In assessing whether it is appropriate to offer you employment in the City of Marion the following questions are important in assisting to assess your suitability to be offered employment.

Have you ever been convicted of any criminal offence, including road traffic offences not resolved by expiation?

Yes

No

If yes, please provide details

NOTE: SPENT CONVICTIONS

You are not required to divulge information about the spent conviction. A spent conviction is a criminal conviction that lapses either immediately or after a period of time pursuant to the provisions of the Spent Convictions Act 2009.

Are you currently facing criminal charges that are yet to be determined?

Yes

No

If yes, please provide details

Have you ever undergone Criminal History Screening and/or other relevant background or history assessments/ screening in the last three years?

Yes

No

If yes, please attach the results of the screening or assessment/s

Please note: In addition to this declaration, you will be asked to agree to Criminal History or other background history screening or assessment. You will not be further considered for an offer of employment with the City of Marion if you do not agree to participate in such history or other background screening or assessment.If you are offered and accept employment in the City of Marion, it will be a condition of such employment that you agree to periodic history or background screening and assessment.

EMPLOYMENT HISTORY

The following questions are also designed to assist in assessing your suitability for employment with the City of Marion with regard to the significant ethical obligations on City of Marion employees.

Has your employment ever been terminated by any organisation or agency, for any reason?

Yes

No

If yes, please provide details

Have you ever been found to have committed misconduct or been performance managed in previous employment?

Yes

No

If yes, please provide details

Are you currently, the subject of an investigation or any other process relating to suspected or alleged misconduct?

Yes

No

If yes, please provide details:

VOLUNTARY SEPARATION OR REDEMPTION OF WORKERS COMPENSATION ENTITLEMENTS

Have you taken a voluntary separation package from the City of Marion, in the last two years?

Yes

No

If yes, please provide detail including date of resignation

ELIGIBILITY TO WORK IN AUSTRALIA

Are you currently eligible to work in Australia?

Yes, I am a permanent resident/citizen

Yes, I have a current work permit / Visa – please attach a copy of the current Work Permit or Visa

No

Please attach a copy of the current Work Permit or Visa

WORKPLACE DIVERSITY

The City of Marion is committed to increasing employment opportunities for First Nations people at all levels within the organisation.

Do you identify with being Aboriginal or Torres Strait Islander?

Yes

No

Prefer not to disclose

DECLARATIONS

DECLARATION: I declare that the information in this declaration and in any other documents completed by me and/or any other statement made by me in support of my application for employment with the City of Marion, and the information provided by me in connection with my application for employment with the City of Marion, including in any interview, is true and correct in every detail.

DISCLOSURE OF CONFIDENTIAL INFORMATION: I acknowledge, that if I am employed in the City of Marion either in the role for which I have been offered or in any other role, I may, during the course of that employment, gain access to confidential information. Detailed provisions regarding disclosure of confidential information are contained in relevant Local Government legislations, regulations, determinations, guidelines and industrial instruments. Without detracting from such sources, unless such information is clearly not of a confidential nature, and unless I am expressly advised to the contrary by someone with requisite authority, policy or as required by law, all information I gain access to as a City of Marion employee is to be treated as confidential. The expression “confidential information” as used in this declaration means all information which must be treated as being of a confidential nature. I understand that I must not disclose or make use of that confidential information, during or after that employment, except in the proper course of my duties and/or with requisite authority and/or otherwise according to law. In particular, I will not use any confidential information gained by virtue of employment with the City of Marion, with the intent of securing a benefit for myself, any person, company or any future employer. In any case where I am in doubt as to whether information gained during employment in the City of Marion is confidential and/or how such information should be managed, I undertake to seek advice and instruction from a People Leader at City of Marion.

POTENTIAL OR ACTUAL CONFLICT OF INTEREST: If I am employed in the City of Marion either in the role for which I have been offered or in any other role, I will not engage in any external or private activities which will result in conflict or potential conflict of interest with any of my duties as a City of Marion employee. I am aware that the detailed provisions regarding conflict of interest and disclosure of conflict of interest are contained in relevant Local Government legislation and guidelines. Without detracting from such sources, in any case where there is any possible doubt regarding a potential conflict of interest, I undertake to seek advice and instruction from a People Leader at City of Marion.

EMPLOYMENT BASE ON PROVISION OF TRUE AND CORRECT INFORMATION: I understand that if I am offered employment in the City of Marion it has been made on the basis that the information that I have provided in connection with my application for employment is true and correct in every detail. I understand that any false statement made in connection with my application for employment in the City of Marion which will include information withheld or incomplete – may lead to a rejection of my application for employment, or, in the event that I am employed or continue employment in the City of Marion, will amount to misconduct and render me liable to disciplinary action, including termination of employment.

Pre-Employment Declaration

RECRUITMENT DECLARATION – APPLICATION FOR EMPLOYMENT WITH THE CITY OF MARION

Instructions to applicants:

MEDICAL AND/OR DISABILITY

CRIMINAL HISTORY

NOTE: SPENT CONVICTIONS

EMPLOYMENT HISTORY

VOLUNTARY SEPARATION OR REDEMPTION OF WORKERS COMPENSATION ENTITLEMENTS

ELIGIBILITY TO WORK IN AUSTRALIA

WORKPLACE DIVERSITY

DECLARATIONS

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