Application Form
Application Form| Page 1
LEADERSHIP | OUTCOMES | LOYALTY | EXCELLENCE
Position Applied for:
Full Name: _________________________________________________________________
Address: _______________________________ Suburb: ________________________
State: _______________ Post Code: _____________________
Email Address: _____________________________________________________________
Mobile: ____________________
Are you?
A current employee of the City of Ballarat? Yes No
A past employee of the City of Ballarat? Yes No Year employment ended:
Right to Work
Please note that in order to work at the City of Ballarat, you must have the legal right or be in the process
to obtain permission to work in Australia. If you do not currently have that right, you may apply for this
position and the Council may be able to assist you in obtaining that right; however, the Council offers
no guarantee of such assistance.
Are you an Australian citizen? Yes No
If No, please tick appropriate evidence that you can provide:
Certificate of evidence of resident status
Valid visa with work right
Please provide any other information that you identify as being pertinent to this application and your
ability to perform the duties of the role: (eg medical conditions, disabilities, criminal history)
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
Application Form
Application Form| Page 2
LEADERSHIP | OUTCOMES | LOYALTY | EXCELLENCE
Privacy Act information and declaration
Your personal information is being collected by City of Ballarat for the purpose of processing your
application. Your information will be stored in Council's Customer Database and used to identify you
when communicating with Council for the delivery of services and information. For further information
on how your personal information is handled, refer to Council's Privacy Policy at
www.ballarat.vic.gov.au
Declaration
I declare that, to the best of my knowledge, the information given is true and correct. I understand
that inaccurate, misleading or untrue statements or knowingly withheld information may result in
termination of employment with this organisation.
Name of Applicant
Signature
Date
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