Job Application Form Test

Surname

Given Name

Address

Suburb

State

Mobile Phone

Home Phone

Email

Gender Select a GenderMaleFemaleOther

No. of dependents

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Part B: Availability to Work

Please tick (✓) which days and times you are available so that we can match this to our site needs.

Please note times listed are approximate and will vary from job to job.

Monday Availability

Tuesday Availability

Wednesday Availability

Thursday Availability

Friday Availability

Saturday Availability

Sunday Availability

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Part C: Previous Employment

Employer Name

Start Date

End Date

Nature of Work

Reason for Leaving

Employer Name

Start Date

End Date

Nature of Work

Reason for Leaving

Employer Name

Start Date

End Date

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Part D: References

Do you agree to have references contacted in relation to this application? (tick one)

Name

Contact Number

Position Held

Name

Contact Number

Position Held

Name

ContactNumber

Position Held

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Part E: Health Assessment

What is your present state of heath?

Are you having any medical treatment/ taking any prescribed medication? please describe

Have you suffered any previous injuries that could affect your work? Please describe.

Nature of injury/disease

Date From

Date To

Was it work related

Nature of injury/disease

Date From

Date To

Was it work Related

Do you now, or have you ever suffered from any of the following? (tick (✓) only those which apply)

If yes, give details.

Do you suffer any disability or impairment of function in your? (tick (✓) only those which apply)

If yes, give details.

Detail any other health issues.

Detail any previous Workers Compensation Claim.

Will you agree to undergo a pre-employment health assessment specific for the requirements of the position as a part of the selection process?

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Part F: Other Information

What is your method of transport?

Do you hold a driver’s license?

Do you have a current Working with Children and Vulnerable People Card?

Do you have a white card?

Do you give consent to undertake a National Criminal History Check and Workers Compensation History Check? (tick one)

Do you have a current National Criminal History Check (less than 6 months old)?

Do you have any convictions recorded?

If yes, give details.

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Part G: Legally entitled to work in Australia

Are you a permanent resident of Australia?

If Yes, evidence provided:

If No, do you have a valid visa with the right to work in Australia?

Visa Expiry Date: