Employee NDIS Consent Form

EMPLOYEE NDIS CONSENT FORM

Employee Name:   Employee ID (if applicable):

Personal Information

Position Information

Proposed Start Date:   Annual Salary / Wage:

Employment History (Most Recent Employers)

Education

Graduation Date:

Professional References

Legal Disclosures

At-Will Employment: I understand that, unless otherwise set out in a separate written agreement signed by an authorized representative of the employer, my employment is at-will and may be terminated by either party at any time, with or without cause or notice. I acknowledge that nothing in this form creates an employment contract for any specific period.

Equal Opportunity: The employer is committed to providing equal employment opportunity and reasonable workplace adjustments where appropriate. Decisions will be made without discrimination on the basis of disability or any other protected characteristic.

NDIS-Related Authorisations and Consents

Purpose: The purpose of this consent is to permit the employer to collect, use and disclose information about the employee that is reasonably necessary to coordinate workplace supports, reasonable adjustments, safety planning and any NDIS-funded supports or services associated with the employee’s role.

By checking the options below I give my informed consent as specified:

I authorize the employer to collect, store and use personal and health-related information that is necessary to assess and implement workplace adjustments and supports.

I authorize the employer to contact my NDIS plan nominee, plan manager or other authorised NDIS representative regarding funding, plan details or service arrangements relevant to workplace supports.

I authorize the disclosure of relevant health assessments, functional capacity reports or occupational therapy recommendations to the employer and designated third-party providers to facilitate reasonable adjustments.

I authorize the employer to share information about my workplace supports with my direct supervisor or manager to implement agreed adjustments.

I consent to the employer or its authorised billing agent using NDIS funding details provided by me to process invoices or claims for workplace support services where applicable and permitted by my plan.

I consent to the disclosure of information to emergency services or medical personnel if required for my safety or the safety of others.

Authorisations Relating to Checks and Contacts

I authorize the employer and its authorised agents to contact my previous employers and the professional referees named in this form to obtain information relevant to my employment, workplace safety and capacity to perform the role with necessary adjustments. I further consent to any pre-employment verification checks that are permitted by law and relevant to my role.

I understand that provision of the information requested is voluntary. Refusal to provide relevant information or to consent to necessary disclosures may affect the employer’s ability to implement supports or to assess my suitability for particular duties.

Privacy, Duration and Revocation

Confidentiality: Information collected under this consent will be treated as confidential and stored securely. Access will be limited to those employees or contractors who require the information to provide supports, manage payroll or manage workplace safety. Exceptions to confidentiality include legal compulsion, mandatory reporting obligations and circumstances involving imminent risk of harm.

Duration: This consent remains in effect from the date signed and will continue until revoked in writing or until the employment relationship ends, whichever occurs first, except where continued retention of records is required by law.

Revocation: I may revoke this consent at any time by providing written notice to human resources. Revocation will not affect actions taken in reliance on this consent prior to receipt of the revocation.

Applicant Certification and Acknowledgement

I certify that all information provided in this form is true, complete and correct to the best of my knowledge. I acknowledge that I have read and understand the authorisations and disclosures contained in this document. I authorise the release and use of information as described above for the purposes stated herein.

Acknowledgement of Rights

I understand that I may request a copy of this consent and any information disclosed pursuant to it, and that I may ask to correct any factual inaccuracies in retained records. I understand the process for revoking consent as described above.

Sign Now