(If any updates or changes in Visa / Passport details, provide it to Emerald Care immediately)

(A ‘YES’ answer will not automatically disqualify you from employment, Since the nature, date, and the job you are applying will also be considered.)

Please Note: You must inform Emarald Care if you become injured or diagnosed with any condition

I declare that in signing below, to the best of my knowledge and belief, all the above information I have provided in relation to my health, is true and correct and that I have not knowingly withheld any information. I understand that if it is later found that I have been untruthful, or that I have knowingly omitted any relevant information, disciplinary proceedings may be introduced against me that might lead to my dismissal from the post to which I have been placed. I understand and agree that if there are any significant changed in my health status after signing this declaration, that it is my duty to inform my consultant, as a further screening of my health may be appropriate.

I understand that where I may undertake an exposure prone procedure, I have an ethical duty to consider if I am placing others at risk of acquiring an infection and must seek appropriate advice and not rely upon my own assessment of risk.

I understand that where the employing organization requires sight of the information gathered within this document and the supporting documentary evidence for the purpose of the placement, Emerald Care may share this information with an appropriately qualified individual.

I hereby confirm that the information given in this application is, to the best of my knowledge, true and correct. I consent to my personal data and my curriculum vitae being forwarded to clients and consent to references being passed onto potential employers. I understand that my registration is subject to the receipt of at least two satisfactory references and an Australian National Police Clearance. I undertake to inform Emerald Care should I be convicted of an offense in the future.

I agree to respect the confidentiality of clients and any other information I may have access to at all times.