Employment Application

EMPLOYMENT APPLICATION - CANDIDATE DETAILS

Date *

First Name *

Surname *

Role you are applying for? *

Do you have the right to work in Australia *

YESNO

Do you identify as Aboriginal/Torres Strait Islander? *

YESNO

Email Address *

Mobile *

Home Address *

Suburb *

State *

Postcode *

INCOME AND EMPLOYMENT TYPE PREFERENCES OR EXPECTATIONS

What are your income expectations? (PLEASE ANSWER AT LEAST ONE OF THE THREE BELOW)

Permanent full time Annual Salary

Permanent P/T or F/T hourly rate?

Casual hourly rate?

Other?

MOST RECENT JOB ROLE

Position

POSITION HELD *

COMPANY *

START DATE OF EMPLOYMENT *

FINISH DATE OF EMPLOYMENT *

Reason for leaving? *

Do you need to give notice to current employer? *

YESNO

If successful when are you available to start? *

Do you have any upcoming commitments/pre-booked holidays?

YESNO

Date(s) of pre-planned holidays / commitment? *

REFEREES / REFERENCE NOMINEES

** WORK references ONLY (not family members or friends)

Must supply MINIMUM OF TWO names and companies who could speak on your behalf

Referee #1

Referee 1 Name: *

Referee 1 Job Role *

Referee 1 : Company *

Referee 1: Contact phone number *

Referee 1: Email address *

Referee #2

Referee 2 Name: *

Referee 2: Job Role *

Referee 2 : Company *

Referee 2: Contact phone number *

Referee 2: Email address *

Occupational Licences & Certificates

Please indicate your licences/training (please provide copy/s with your application)

First Aid

First Aid - Senior

First Aid Expiry Date:

Perform CPR

CPR Expiry Date:

Drivers Licence

C Class Drivers Licence

DL number and Expiry Date:

Qualifications and Accreditations

** Please advise your qualifications and note you will be required to provide certificates on offer of employment**

Certificate

Diploma

Degree

Other or additional

Accreditations: (AHPRA, ESSA etc)

Health and Safety / Medical Questionnarie

Please answer the following questions and provide details where applicable.

Do you have any pre-existing injuries that would prevent you from completing the inherent requirements of the job role? *

YESNO

Please provide details

Do you have any pre-existing illness that would prevent you from or be aggravated by completing the inherent requirements of the job role? *

YESNO

Details

Are you currently taking any medication that could impact your ability to perform the role? *

YESNO

Details

Do you now or have you ever had any concerns with the following?

Loss of hearing that would impact your ability to communicate on the telephone or normal conversation *

YESNO

Details

Do you have or have you ever had limitations on ability to sit or stand for prolonged periods in one spot? *

YESNO

Details

Do you have any current restrictions lifting? *

YESNO

Details

Foot trouble, difficulty wearing shoes? *

YESNO

Details

Mental, Nervous disorders, Claustrophobia, Depressive illness, Anxiety attacks, Stress related disorders? *

YESNO

Details

If yes, could the above existing condition or medication impact the safety of others or be aggravated by, or impact your ability to perform, the inherent requirements of the role?

YESNO

The below questions are around your safety, and ensuring we are aware of any medical emergency that could present.

Blackouts, fainting attacks? *

YESNO

Details

Fits, Epilepsy? *

YESNO

Details

Type 1 Diabetes? *

YESNO

Details

Arthritis, Rheumatism? *

YESNO

Details

Hernia? *

YESNO

Details

Drugs and Alcohol in the Workplace - Zero Tolerance Policy

We have a zero tolerance policy for the consumption and presence of drugs and alcohol whilst at work.

Drug and Alcohol testing will occur and is on a random basis

Do you have any concerns undergoing Drug and Alcohol testing? *

YESNO

PRIVACY & PERSONAL INFORMATION CONSENT

Please complete the following consent statement

I, *

consent to the collection of necessary personal information, including age, gender, medical and functional history, address details and contact infromation.

I agree to undertake any / all medical tests, physical assessments and / or drug and alochol screening as required to ensure my capability to perform the tasks required of the position for which I have applied.

I hereby declare that the information I have provided in this form is true and accurate and I authorise the company to verify any information if required. Any false or misleading information may result in the termination of my position / application.

I have read and understood my rights in respect of access to and collection of my personal information.

Signed *

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