Personal Information

Expression of Interest

CIRCA Research is seeking to expand its network of research consultants from CALD, Aboriginal and Torres Strait Islander, and disability backgrounds.

If you want to join our network, please complete the form below with the required information.

Need help filling out this form?

If you need assistance, you can contact the CIRCA core team, and we will be happy to help you complete this form over the phone.Call us on: 02 8585 1325

Personal Information

First Name *

Last Name *

Preferred Name

Mobile *

Telephone

Email Address *

Address

Suburb *

State *

Postcode *

Postal Address (if different)

Postal Suburb

Postal State

Postal Postcode

Your Gender *

Do you identify as Aboriginal and/or Torres Strait Islander? *

If Aboriginal and/or Torres Strait Islander, to which Aboriginal and/or Torres Strait Islander communities are you connected *

To help us understand any connections you may have to the disability community, please select all categories that apply to you: *

I identify as a person with a disability.I am an unpaid carer for a person with a disabilityI am a paid Disability Support WorkerNone of the above.Prefer not to say.

What disability (ies) do you identify with? *

Which disability(ies) have you supported most as an unpaid carer or paid Disability Support Worker? *

What is your cultural background? *

Where were you born (Country or place of birth)? *

What language(s) do you speak? Please indicate ALL languages you are fluent in. *

What is the highest level of education that you have completed? e.g. PHD, Diploma, Certificate IV etc *

What type of certifications do you have? e.g. Diploma of Community Services, Nationally Accredited Mediator, Facilitation Certificate etc

How did you hear about CIRCA?

Skills

If you have other skills or expertise not listed above relevant to research work, please outline them here:

Have you facilitated focus groups, or conducted interviews or meetings via videoconference? (For example, Zoom, Google Meet or Teams) *

In an exceptional circumstance, would you be willing to undertake projects with a fast turnaround? For example, a project where you would only have 5 days to recruit participants and facilitate the Focus group or interview? *

Please list any trauma-informed interviewing experience (e.g. homelessness, mental health, domestic violence, etc…)

Current Employment Status

Please indicate which of the following is most relevant: *

Availability

Please select the boxes most relevant to you: *

Available during the weekday between 9am – 5pmAvailable during the weekday after 5pm Available during the weekend between 9am – 5pmAvailable during the weekend after 5pm

Availability to Travel

Please name the places/communities or the furthest distance from your home you would be willing to travel for research work

Please upload your curent CV below.

CV Upload

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We will contact you shortly.

Thank you,

CIRCA Research Team.

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