New Employee Intake Form | Compass Dental Care

Personal Details

Surname / Family Name *

Surname is required

Given Name(s) *

Given name(s) required

Preferred Name

Date of Birth *

Date of birth is required

Gender

Residential Address

Suburb

State

Postcode

Mobile Number *

Mobile number is required

Home / Alternative Phone

Email Address *

Valid email address is required

Emergency Contact

Full Name *

Emergency contact name is required

Relationship

Phone Number *

Emergency contact phone is required

Email Address

Employment Details

Position / Job Title *

Position is required

Start Date *

Start date is required

Employment Type

Full-time Part-time Casual

Right to Work in Australia

Australian Citizen or Permanent Resident?

Yes No

Visa Type

Visa Expiry Date

Visa Grant Number

Tax File Number Declaration

Tax File Number (TFN) *

TFN is required

ABN (if applicable)

Claiming Tax-Free Threshold?

Yes No

HELP / HECS Debt?

Yes No

Financial Supplement Debt?

Yes No

Bank Account Details

Account Name *

Account name is required

BSB *

BSB is required

Account Number *

Account number is required

Superannuation

Do you have an existing super fund?

Yes No

Fund Name

Member Number

USI

Fund ABN

Qualifications & Registrations

Relevant Qualifications

AHPRA Registration Number

AHPRA Expiry Date

Current First Aid Certificate?

Yes No

CPR Certificate Expiry

Working with Children Check (Ochre Card) Number

Ochre Card Expiry Date

National Police Check Completed?

Yes No

Date Obtained

Health & Medical

Do you have any medical conditions or allergies?

Yes No

Please provide details

Immunisations up to date? (Hepatitis B, COVID-19, Influenza)

Yes No

Declaration

I declare that:

The information provided in this form is true and correct to the best of my knowledge. I understand that providing false or misleading information may result in disciplinary action or termination of employment.
I will notify Compass Dental Care promptly of any changes to my personal details, qualifications, registration status, or right to work in Australia.
I consent to Compass Dental Care collecting and storing the personal information provided in this form for the purposes of employment administration, payroll, and compliance with legal obligations. This information will be handled in accordance with the Australian Privacy Principles.

Employee Signature *

Sign here

Signature is required

Date