cdcstaffform – Cosmos Divine Care

1800 953 997

Home
Our Service
Pricing
Service Referral Form
Contact
Cosmos Documents

Contact Info

1800 953 997

Please enable JavaScript in your browser to complete this form.

- Step 1 of 5

INSTRUCTIONS

Please carefully read the following instructions since they will assist you in completing this form as quickly and efficiently as possible.

Keep the following documents handy for a smooth process.

An updated CV/resume
100 points identification documents (passport, driver's license, visa, Medicare, etc.)
NDIS Worker Screening
National Police Check
Working with children Check
Certifications and qualifications relevant to the industry, such as Certificates, Diplomas, First Aid and CPR, and Manual Handling.
Any experience or reference letters you may have
Documents related to your vehicle registration and insurance.

The following documents can be downloaded and pre-filled to be attached with this form.

Download Superannuation Form

Download TFN Declaration Form ATO

PRIVATE AND CONFIDENTIAL

EMPLOYEE DETAILS

PERSONAL DETAILS

Layout

STAFF NAME *

Address *

Address Line 1

City

State / Province / Region

Country

Date of Birth *

Phone *

Email *

EMERGENCY CONTACT DETAILS

EMERGENCY CONTACT

Layout

Emergency Contact (1) *

Emergency Contact (2)

Relationship *

Relationship

Contact Number *

Phone

FINANCIAL DETAILS

BANKING INFORMATION

Layout

Account Held Under *

BSB *

Account Number *

SUPERANNUATION

Layout

SUPERANNUATION NAME *

SPIN/USI *

ABN *

Member Number *

AUSTRALIAN TAXATION DETAILS

Layout

Tax File Number *

HECS/HELP/SSL/TSL DEBT? *

YES
NO

ABN Number (if applicable)

Claiming Tax Free Threshhold? *

YES
NO

WORK RIGHTS DETAILS

1. Are you an Australian Citizen? *

YES
NO

2. If not an Australia Citizen, Are you an Australian Permanent Resident? *

YES
NO
NOT APPLICABLE

3. If your answer is 'NO' to both question 1 and 2, Do you have a Valid Work VISA and/or a VISA with working rights? *

YES
NO
NOT APPLICABLE

VISA DETAILS

Layout

VISA Grant Number

Any Restrictions on Visa

YES
NO

Provide details of any VISA restrictions:

VISA GRANT FILE

Click or drag a file to this area to upload.

You can attach your VISA document here.

VISA Type/Category

Expiry Date

Layout

Signature *

Dated *

Code of Conduct

Read Code of Conduct

Acknowledgement *

An electronic copy of the Code of Conduct has been provided to me.
It is my acknowledgement that I have read and understood the code of conduct.

Layout

Staff Name *

Signature: *

Dated *

Layout (copy)

Cosmos Divine Care Representative

Dated

CONFLICT OF INTEREST - Declaration Form

SECTION 1: PERSONAL DETAILS

Layout

STAFF NAME *

Job Title / Area of Responsibility *

Phone *

Email *

SECTION 2: DISCLOSURE DETAILS

The actual, potential or perceived conflict of interest relates to: (tick all appropriate box/s) *

Management
Outside work activities (paid/unpaid)
Financial Interest
Gifts/benefits
Participant
Participant enrolled in another provider
Staff recruitment
Relationship with external parties
Provision of external consultancy services
Other (if you selected other please provide details)

The following actual, potential, or perceived conflict of interest has been identified. (Please insert all relevant details here).

The (actual, potential or perceived) conflict is expected to last: *

0 – 12 months
>12 months or ongoing

SECTION 4: DECLARATION

To the best of my knowledge and belief any actual, perceived or potential conflicts between my duties as a stakeholder of Cosmos Divine Care and my private and/or business interests have been fully disclosed in this form in accordance with the requirements of Cosmos Divine Care Conflict of Interest Policy. I acknowledge, and agree to comply with, any approach identified in this form for removing or managing an actual, perceived or potential conflict of interest.

Layout (copy)

Signature *

Date *

SECTION 3: OFFICE USE ONLY

TO BE COMPLETED BY COMPANY REPRESENTATIVE / SERVICE PROVIDER

In my opinion the details provided: (tick appropriate box)

do not constitute a conflict of interest, and I authorise the employee to continue the activity (go to Section 4).
do constitute an actual, potential or perceived conflict of interest (please provide a detailed action plan below).

If the situation does constitute a conflict of interest, please ensure that the following actions have been considered:

Ensure all information surrounding the conflict has been disclosed and documented.
Inform likely affected persons of the conflict, seeking their views where relevant as to whether they object.
Reformulate the scope of work or restricting access to certain information.
Recruit a third party to oversee part or all of the process.
Recommend relinquishing the interest that is causing the conflict
Temporarily remove the person from the process or responsibilities
Monitor the person’s activities closely in relation to the conflict of interest
Take no further action because the conflict is minimal.

I have reviewed the above considerations and request that the Employee takes the following action to eliminate/manage the conflict:

I will ensure this action plan is reviewed:

Within 1 month
Within 3 months
Within 6 months
Within 12 months
Other – specify
N/A: the conflict is one-off or short duration

Layout

Signature

Date

SECTION 5: PRINCIPAL / PROVIDER

The actions described in the approach outlined in Section 3 have been put in place to effectively manage any actual, potential or perceived conflict of interest disclosed in Section 2. The approach outlined in Section 3 ensures that the Cosmos Divine Care public interests and reputation is adequately protected.

Layout

Cosmos Divine Care Representative

Signature

Date

Staff Employee Handbook / Policy and Procedures Manual

Read Staff Employee Handbook

Read Cosmos Divine Care Policy and Procedures Manual

Read Cosmos Divine Care Fair Work Information Sheet

Read Cosmos Divine Care Casual Employement Information Statement

Read Cosmos Divine Care Position Description

Acknowledgement *

Cosmos Divine Care has provided me with an electronic copy of their staff / employee handbook.
I have received an electronic copy of Cosmos Divine Care's policy and procedure manual.
I confirm that I have read and understood the Policy and Procedures Manual.
I confirm that I have read, understood and agree with the Contractor Agreement provided.
The contractor agrees to provide the services for Cosmos Divine Care as a contractor on the terms and conditions set out in the Contractor Agreement.

Layout

Signature *

Dated *

Layout

Staff CV / Resume *

Click or drag a file to this area to upload.

National Police Check *

Click or drag a file to this area to upload.

100 Points of ID Check (Passport , Driver Licence, Medicare Card, Health Insurance Card etc) *

Click or drag files to this area to upload. You can upload up to 5 files.

Experience Letter or Reference Certificates *

Click or drag files to this area to upload. You can upload up to 4 files.

File Upload TFN Declaration Form ATO *

Click or drag a file to this area to upload.

NDIS Worker Screening *

Click or drag a file to this area to upload.

Working with Children Check *

Click or drag a file to this area to upload.

Relevant Industry Qualifications (Certificates, Diploma, First Aid, CPR, Manual Handling, Medication administration etc) *

Click or drag files to this area to upload. You can upload up to 6 files.

Vehicle Registration and Insurance Details *

Click or drag files to this area to upload. You can upload up to 2 files.

File Upload Superannuation Form *

Click or drag a file to this area to upload.

About Us

As a Registered NDIS provider, Cosmos Divine Care provides services in a unique manner. Every participant receives a personalized approach and our services are tailored to meet the needs of each individual.

The Cosmos Divine Care team acknowledges the traditional owners and custodians of the country throughout Australia. We acknowledge their continuing connection to land, sea, and community. Respect is expressed to the people, the cultures, and the elders past, present, and emerging.

Contact Info

Office (by Appointments Only)

40 Le Page Run, South Morang, 3752 Victoria
1800 953 997
info@cosmosdivinecare.com.au

Further Information
What is NDIS?
Support Network - Ask Izzy
About COVID-19
NIDS Pricing

© 2024 Cosmos Divine Care. All Rights Reserved.

Privacy Policy.
Terms