Have you been provided with a Civifleet Contractor Number?
Yes
No
This number can be found on your letter of Contractor Registration Approval.
Contractor Number
*
CASE Sensitive
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Business Information
Business Name
*
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Driver/Operator Information
Driver/Operator Name (as appears on licence)
*
First Name
Middle Name
Last Name
Driver Mobile Number
*
-
Area Code
Phone Number
COVID-19 Vaccination?
*
Yes
No
What is your vaccination level?
*
First Dose
Both Dose
Both Doses, Plus Booster
Please upload your Proof of Vaccination (e.g. vaccination certificate)
*
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Driver Emergency Contact
Full Name
*
First Name
Last Name
Mobile Phone Number
*
-
Area Code
Phone Number
Home Phone Number
-
Area Code
Phone Number
Work Phone Number
-
Area Code
Phone Number
Relationship
*
Parent
Partner
Spouse
Sibling
Other
Other
*
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Driver Licence Information
Do you have vehicle Licence?
*
Yes
No
Driver Licence Classification (tick all that apply)
*
HC - Heavy Combination
HR - Heavy Rigid
LR - Light Rigid
L - Learners Permit
MC - Multi Combination
MR - Medium Rigid
P - Probationary
R - Motorcycle
Other
State of Issue
*
Victoria (VIC)
Western Australia (WA)
South Australia (SA)
Northern Territory (NT)
Queensland (QLD)
New South Wales (NSW)
Australian Capital Territory (ACT)
Tasmania (TAS)
Licence Number
*
Licence Number
*
Licence Number
*
Licence Number
*
Licence Expiry
*
/
Day
/
Month
Year
Please provide a copy.
*
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Qualifications and Competencies
Do you have an OH&S Industry Induction Card (White/Red Card)?
*
Yes
No
Card Number
*
State of Issue
*
Victoria (VIC)
Western Australia (WA)
South Australia (SA)
Northern Territory (NT)
Queensland (QLD)
New South Wales (NSW)
Australian Capital Territory (ACT)
Tasmania (TAS)
Please provide a copy.
*
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Qualifications and Competencies
Do you have an EPA Card?
*
Yes
No
EPA Card Number
*
Please provide a copy.
*
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Qualifications and Competencies
Do you have a Rail Ticket?
*
Yes
No
Rail Ticket Number
*
Please provide a copy.
*
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Plant CoC Information
Do you have any certificates of competency for plant (machinery tickets)?
*
Yes
No
Ref. Number
*
Please provide a copy.
*
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of
CoC's (tick all that apply under this number)
*
LB - Front-end loader backhoe
LBG - Bridge and gantry (remote control) crane
LD - Dragline
LE - Excavators
LG - Graders
LL - Front-end loaders
LP - Scrapers
LR - Road-rollers
LS - Skid steer loaders
LZ - Dozers
Other
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Plant CoC Information
Do you have any further certificates of competency for plant (machinery tickets)?
*
Yes
No
Ref. Number
*
Please provide a copy.
*
Browse Files
Cancel
of
CoC's (tick all that apply under this number)
*
LB - Front-end loader backhoe
LBG - Bridge and gantry (remote control) crane
LD - Dragline
LE - Excavators
LG - Graders
LL - Front-end loaders
LP - Scrapers
LR - Road-rollers
LS - Skid steer loaders
LZ - Dozers
Other
Back
Next
Plant CoC Information
Do you have any further certificates of competency for plant (machinery tickets)?
*
Yes
No
Ref. Number
*
Please provide a copy.
*
Browse Files
Cancel
of
CoC's (tick all that apply under this number)
*
LB - Front-end loader backhoe
LBG - Bridge and gantry (remote control) crane
LD - Dragline
LE - Excavators
LG - Graders
LL - Front-end loaders
LP - Scrapers
LR - Road-rollers
LS - Skid steer loaders
LZ - Dozers
Other
Back
Next
Plant CoC Information
Do you have any further certificates of competency for plant (machinery tickets)?
*
Yes
No
Ref. Number
*
Please provide a copy.
*
Browse Files
Cancel
of
CoC's (tick all that apply under this number)
*
LB - Front-end loader backhoe
LBG - Bridge and gantry (remote control) crane
LD - Dragline
LE - Excavators
LG - Graders
LL - Front-end loaders
LP - Scrapers
LR - Road-rollers
LS - Skid steer loaders
LZ - Dozers
Other
Back
Next
Plant CoC Information
Do you have any further certificates of competency for plant (machinery tickets)?
*
Yes
No
Ref. Number
*
Please provide a copy.
*
Browse Files
Cancel
of
CoC's (tick all that apply under this number)
*
LB - Front-end loader backhoe
LBG - Bridge and gantry (remote control) crane
LD - Dragline
LE - Excavators
LG - Graders
LL - Front-end loaders
LP - Scrapers
LR - Road-rollers
LS - Skid steer loaders
LZ - Dozers
Other
Back
Next
Plant CoC Information
Do you have any further certificates of competency for plant (machinery tickets)?
*
Yes
No
Ref. Number
*
Please provide a copy.
*
Browse Files
Cancel
of
CoC's (tick all that apply under this number)
*
LB - Front-end loader backhoe
LBG - Bridge and gantry (remote control) crane
LD - Dragline
LE - Excavators
LG - Graders
LL - Front-end loaders
LP - Scrapers
LR - Road-rollers
LS - Skid steer loaders
LZ - Dozers
Other
Back
Next
Plant CoC Information
Do you have any further certificates of competency for plant (machinery tickets)?
*
Yes
No
Ref. Number
*
Please provide a copy.
*
Browse Files
Cancel
of
CoC's (tick all that apply under this number)
*
LB - Front-end loader backhoe
LBG - Bridge and gantry (remote control) crane
LD - Dragline
LE - Excavators
LG - Graders
LL - Front-end loaders
LP - Scrapers
LR - Road-rollers
LS - Skid steer loaders
LZ - Dozers
Other
Back
Next
Plant CoC Information
Do you have any further certificates of competency for plant (machinery tickets)?
*
Yes
No
Ref. Number
*
Please provide a copy.
*
Browse Files
Cancel
of
CoC's (tick all that apply under this number)
*
LB - Front-end loader backhoe
LBG - Bridge and gantry (remote control) crane
LD - Dragline
LE - Excavators
LG - Graders
LL - Front-end loaders
LP - Scrapers
LR - Road-rollers
LS - Skid steer loaders
LZ - Dozers
Other
Back
Next
Plant CoC Information
Do you have any further certificates of competency for plant (machinery tickets)?
*
Yes
No
Ref. Number
*
Please provide a copy.
*
Browse Files
Cancel
of
CoC's (tick all that apply under this number)
*
LB - Front-end loader backhoe
LBG - Bridge and gantry (remote control) crane
LD - Dragline
LE - Excavators
LG - Graders
LL - Front-end loaders
LP - Scrapers
LR - Road-rollers
LS - Skid steer loaders
LZ - Dozers
Other
Back
Next
Plant CoC Information
Do you have any further certificates of competency for plant (machinery tickets)?
*
Yes
No
Ref. Number
*
Please provide a copy.
*
Browse Files
Cancel
of
CoC's (tick all that apply under this number)
*
LB - Front-end loader backhoe
LBG - Bridge and gantry (remote control) crane
LD - Dragline
LE - Excavators
LG - Graders
LL - Front-end loaders
LP - Scrapers
LR - Road-rollers
LS - Skid steer loaders
LZ - Dozers
Other
Back
Next
Plant CoC Information
Do you have any further certificates of competency for plant (machinery tickets)?
*
Yes
No
Ref. Number
*
Please provide a copy.
*
Browse Files
Cancel
of
CoC's (tick all that apply under this number)
*
LB - Front-end loader backhoe
LBG - Bridge and gantry (remote control) crane
LD - Dragline
LE - Excavators
LG - Graders
LL - Front-end loaders
LP - Scrapers
LR - Road-rollers
LS - Skid steer loaders
LZ - Dozers
Other
Back
Next
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