STAFF-IN-CONFIDENCE (when completed) AUSTRALIAN HIGH COMMISSION VISA OFFICE REGISTRATION & PERSONAL PARTICULARS FORM PARTICULARS OF POSITION

APPLIED FOR Position applied for PERSONAL PARTICULARS Title Surname Given Names Other names you are or have been known by Of which countries are you a citizen? Date & place of birth Residential address Postal address Home phone number Mobile number Alternative contact number Email address Marital status Details of family eg Mr, Mrs, Miss, Dr

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EMPLOYMENT

If you answer yes to any of these questions, provide full details including occupation/designation and period of employment.

Current employment Are you currently employed by, or have you previously been employed by the Australian High Commission?

Are any of your family members (including extended family) employed by the Australian High Commission in any capacity? This includes domestic workers. Are you currently employed by, or have you previously been employed by another Embassy or High Commission? Are any of your family members (including extended family) employed by another Embassy or High Commission or Government of India in any capacity? This includes domestic workers. Have you or any of your family members (including extended family) ever been employed by a migration agent, education agent or travel agency in any capacity? Have you ever been employed by the Indian government or military? Have you ever been disciplined for misconduct at any employment? List employment experience on a separate page Include contact details of employer, occupation, period of employment and

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OVERSEAS TRAVEL

If yes to any of these questions, include full details of passport number, place of issue, date of expiry, details of previous passports held, countries visited, countries of residence, dates of visits, dates of residence

Details of your passport Have you ever visited overseas? If yes to any of these questions, include full details of passport number, place of issue, date of expiry, details of previous passports held, countries visited, countries of residence, dates of visits, dates of residence

OVERSEAS TRAVEL

If married, has your spouse ever visited overseas? Do you have any relatives residing overseas? Do you have any friends or relatives who live in Australia? SUPERVISORS Current supervisors name Contact number Duration of relationship Immediate previous supervisors name Contact number

Duration of relationship WRITTEN REFERENCES (if provided) Referees name Contact number Referees name Contact number EDUCATION Qualification/s Institution/s & year attained LANGUAGES Provide details of languages spoken and proficiency levels (basic, intermediate, advanced) Have you undertaken an IELTS exam? If yes, attach results. HEALTH AND CHARACTER Why do you want to work at the Australian High Commission Visa Office? Have you ever been convicted of a crime or offence in any country? Have you ever been charged with If you answer yes to any of these questions, provide full details on a separate page.

Have you ever been convicted of a crime or offence in any country?

any offence that is currently awaiting legal action? Do you know of any threatened legal action against you for any act or omission by you Have you ever been acquitted of any criminal offence? Have you ever been involved in any activities that would represent a risk to Australian national security or the reputation of the Australian government? Have you ever been involved in any activity relating to illegal movement of people, goods, arms, drugs or any illegal or prohibited substance to any city in India or to any country? Are there any medical issues which may affect your ability to work in an office for eight hours per day, five days per week, with occasional overtime?

Are there any factors in relation to your health or other factors in relation to your character which you feel would affect your ability to work at the Australian High Commission Visa Office?

Is there any other matter you would like us to be aware of which you feel is material and should be informed to us with regard to your application?*

Concealment of material information is a serious offence and amounts to a knowing and deliberate misrepresentation. Applicants Statement The above information, to the best of my knowledge, is true and correct and I have not concealed any material information there from. I consent to the Australian High Commission collecting and using information, and to relevant employers disclosing information, in relation to my work performance and conduct for the purpose of assessing my suitability to carry out the duties of the job I have applied for, and suitability to become an employee at the Australian High Commission Visa Office. WARNING: Giving false or misleading information or making a misrepresentation is a serious offence. Values Statement The Department of Immigration and Citizenship is committed to maintaining the integrity of its staff in its endeavour to deliver excellent services within its visa and citizenship programs. Officers representing the Department must uphold the highest levels of personal integrity and professionalism in all areas of their life. By signing below, you undertake that you are of good character, have provided honest answers, and will display and uphold integrity, professionalism and act ethically in the course of your duties.

____________________________ Signature and date

____________________________ Name (in block letters)