Resource Labour Hire Candidate Registration Form
Name
*
First Name
Last Name
Name you'd like to be known by:
Date of Birth
*
-
Day
-
Month
Year
Date
Mobile
*
Please enter a valid phone number.
Email (for payslips)
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Employee Next of Kin
Emergency Contact
Name
*
First Name
Last Name
Relationship with employee (i.e. Spouse, Parent, Relative etc)
*
Contact number
*
Please enter a valid phone number.
Working Rights
Eligibility to work legally in Australia
Are you an Aboriginal and/or Torres Strait Islander of Australian origin?
*
Please Select
Yes
No
Prefer not to say
Are you 1. An Australian Citizen 2. Resident 3. Visa
*
1. Australian Citizen
2. Permanent Resident
3. Visa
Please provide proof / evidence of Citizenship / Residency / VISA
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Visa Type and number:
Visa Expiry Date:
Third Party Permission
If you are registered with a Job Active provider, you may be entitled to additional funds to cover any out of pocket employment costs. Examples of out of pocket expenses may include: - Tools for Work - Transport - Company uniforms, PPE - Vests, Hard Hats, Boots - Additional Training / Upskilling - Vaccinations and Medical specifics
Are you currently registered with a Job Active Provider?
*
Please Select
Yes
No
Examples of Job Active providers are: - MAX Employment - Sarina Russo - Tursa - Neato - Salvation Army Employment Plus - Best Employment - Help Employment - Joblink Plus
Do you consent for your information to be passed on to relevant third parties when related to your employment?
*
Please Select
Yes
No
Employee Work Ready Details
PPE Shirt Size
*
Max distance willing to travel (e.g. 30km)
*
What tickets / licences do you have? (e.g. White card, Forklift, WWC, Police Check etc)
*
Fitness For Work
Are you taking regular medication which impacts on our ability to safety perform your role? (e.g. prescription medicine causing drowsiness)
*
Please Select
Yes
No
If yes, please provide further information
Do you suffer from allergies?
*
Please Select
Yes
No
If yes, please provide further information
Do you have any neck, spinal, head injuries or neck, back or limb disorders?
*
Please Select
Yes
No
If yes, please provide further information
Do you have any psychiatric illness or nervous disorder?
*
Please Select
Yes
No
If yes, please provide further information
Have you been absent from work due to chronic ill health or injusry during the last 2 years?
*
Please Select
Yes
No
If yes, please provide further information
Do you suffer from double vision or colour blindness or difficulty seeing?
*
Please Select
Yes
No
If yes, please provide further information
Have you ever been diagnosed with a sleeping disorder?
*
Please Select
Yes
No
If yes, please provide further information
Have you ever been diagnosed with heart disease, Angina or chest pains or had heart surgery?
*
Please Select
Yes
No
If yes, please provide further information
Have you ever been diagnosed with High Blood Pressure?
*
Please Select
Yes
No
If yes, please provide further information
Have you ever been diagnosed with Kidney disease, Diabetes or Arthritis?
*
Please Select
Yes
No
If yes, please provide further information
Have you ever had any serious injury, illness or been hospitalised for any reason?
*
Please Select
Yes
No
If yes, please provide further information
Have you ever lodged a Workers Compensation Claim?
*
Please Select
Yes
No
If yes, please provide further information
Have you ever suffered from deafness or had an ear operation or used a hearing aid?
*
Please Select
Yes
No
If yes, please provide further information
Are you currently being treated by a doctor for any illness or medical condition?
*
Please Select
Yes
No
If yes, please provide further information
Is there any reason that prevents you from wearing appropriate Personal Protective Equipment?
*
Please Select
Yes
No
If yes, please provide further information
Do you have a family history of any medical condition?
*
Please Select
Yes
No
If yes, please provide further information
Do you have any medical conditions needing to be monitored regularly?
*
Please Select
Yes
No
If yes, please provide further information
Would you be able to pass a drug and alcohol test at any time during your employment?
*
Please Select
Yes
No
Do you need to wear prescription glasses for work?
*
Please Select
Yes
No
Do you have any medical condition preventing you from performing manual handling activities?
*
Please Select
Yes
No
If yes, please provide further information
Do you have any difficulties running 100 metres?
*
Please Select
Yes
No
Do you have any difficulties walking around on rough ground, kneeling, standing continuously for 2 hours?
*
Please Select
Yes
No
Do you have any difficulties crouching or squatting, lifting or bending, turning your head rapidly ?
*
Please Select
Yes
No
Do you have any difficulties climbing a ladder?
*
Please Select
Yes
No
Do you have any difficulties using tools?
*
Please Select
Yes
No
Do you have any difficulties using hand tools?
*
Please Select
Yes
No
Do you have any difficulties gripping firmly with one or both hands?
*
Please Select
Yes
No
Do you have any difficulties doing repetitive movements with the arms or legs?
*
Please Select
Yes
No
Do you have any difficulties concentrating for lengthy periods?
*
Please Select
Yes
No
Have you had any exposure to asbestos in your previous employment history?
*
Please Select
Yes
No
If yes, please provide further information
Have you had any exposure to hazardous or dangerous chemicals in your previous employment history?
*
Please Select
Yes
No
If yes, please provide further information
Have you had any exposure to radiation in your previous employment history?
*
Please Select
Yes
No
If yes, please provide further information
Have you had any exposure to dusty environments in your previous employment history?
*
Please Select
Yes
No
If yes, please provide further information
Have you undergone a hearing test in the past 12 months?
*
Please Select
Yes
No
If yes, please provide further information
Do you practice any fasting activities (medical or religious purposes?)
*
Please Select
Yes
No
What is your approximate weight?
*
What is your approximate height?
*
Please upload a photo that can be used as an ID for your Resource Labour Hire profile
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Injury Management Details
Have you ever had a work related injury/illness or made a claim for Workers Compensation?
*
Please Select
Yes
No
If you have selected Yes, please fill out the following
AUTHORITY TO OBTAIN MEDICAL INFORMATION
I authorise Resource Labour Hire and their employees to obtain information on my behalf relevant to workers compensation and rehabilitation that may be necessary for consideration of future injury management programs. I understand that all information gathered will be used in the strictest confidence by Resource Labour Hire and is provided only to members of the injury management case team as required
*
Please Select
Yes
No
MEDICAL ASSESSMENTS & DRUG SCREENING
I accept that some positions will require pre-placement medical assessments and/or drug screening and if I fail either of these tests due to non-disclosure of information, I may be required to reimburse Resource Labour Hire for any costs incurred
*
Please Select
Yes
No
Privacy Policy
Resource Labour Hire is committed to providing quality services to you and this policy outlines our ongoing obligations to you in respect of how we manage your personal information. We have adopted the Australian Privacy principles (APPs) contained in the Privacy Act 1988 (cth) (the privacy act) The NPPs govern the way in which we collect, use, disclose, store, secure and dispose of your personal information. A copy of the Australian Privacy principles may be obtained from the website of the Office of the Australian Information Commissioner at www.aoic.gov.au
Do you understand that any sensitive information viewed, scanned, emailed or saved is the property and remains the property of Resource Labour Hire exclusively?
*
Please Select
Yes
No
Do you understand that if any sensitive information is found to have been passed to any person(s), legal proceedings may be taken against you.
*
Please Select
Yes
No
Fair Work Statement
I declare that I have read and understood the casual employment information statement by Fair Work Australia
*
Please Select
Yes
Candidate Declaration
I declare that I have read and understood the RLH Employee Safety Handbook
*
Please Select
Yes
I agree to employment with Resource Labour Hire on the terms and conditions set out in this employment contract, and agree that by commencing employment I have accepted the details outlined in my Assignment Confirmation for that assigment
*
Please Select
Yes
No
I declare that the information I have given is true and correct.
*
Please Select
Yes
No
Please sign to declare that the information you have given is true and correct.
*
Submit
Should be Empty: