Pre-Assessment Online Forms

Welcome!

This page is for individuals booked in for psychological assessment / screening for working with children.

Online form below:

Identification Declaration
Consent
Pre-Assessment Questionnaire

Please make sure you complete all 3 sections.

If you have any issues please contact us by phone 08 7200 3205

or email us ( admin@paradigmassessments.com.au ) and we will do our best to assist you.

Thank you

Identification Declaration, Consent Form and Pre-Assessment Questionnaire

Identification Declaration:
Name Details:: First Name:

Last Name:
Date of Birth:
Preferred Name/Nickname:
Address Details:: Line 1:

Line 2:

City:

Country:

State:

Postal Code:
Contact Number:
Email Contact:
Previous Names/Aliases:
Previous Names/Aliases 2:
Previous Names/Aliases 3:
Declaration:: Confirm

I declare the above information to be accurate and complete (tick box)
Consent Form:
Today's Date:
:: Privacy Disclaimer: Collection of the information provided in this form and any attachments is authorised under the 'Children & Young People (Safety) Act 2017' and is being used for applying to the Department for Child Protection for the purpose of approval of your organisation's psychological assessment approach. I agree to participate in the psychological assessment that will assist in determining my appropriateness to work with children. I am aware the assessment will involve me providing an accurate history about myself. I am aware the assessment will involve me undertaking a number of psychometric tests.
Consent:: Yes, I consent
Pre-Assessment Questionnaire:
Family History: Please outline 1) Your relationship with your parents, 2) Your relationship with any siblings, and 3) Where you grew up:
Relationship History: Please outline your history of significant relationships (especially where children are/were involved):
Educational History: 1) Please outline the primary and secondary schools you attended, and your achievements at school. 2) Please also outline any post-secondary education courses or programs you have completed:
Vocational History: Please outline the jobs you have had since leaving school (with approximate dates), and the reasons you had (if any) for leaving those jobs:
Physical and Mental Health History: 1) Physical Health History: Please outline your history of health problems since childhood. Please also include whether you see a regular GP/Medical Practitioner and the details of this:
Physical and Mental Health History: 2) Mental Health History: Please outline your history of mental health problems since childhood. Please include if you see a regular therapist and the details of this:
Substance Use History: Please outline any history of alcohol and other substance use history:
Gambling History: Please outline any history of gambling and whether you consider it a problem for you:
Criminal & Disciplinary History: Please detail any prior history of offending (e.g., drink driving) and the outcome. Please also indicate from your history in the workforce any instances where you have been subject to disciplinary measures:
Confirmation:: Confirm

I declare that to the best of my knowledge the above information is true and accurate, and I have not attempted to conceal any information
Spam Verification: