Pronto Employment Services Registration Form
Name
*
First Name
Last Name
Date of Birth
*
-
Day
-
Month
Year
Date
Mobile
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email (for payslips)
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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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.
Format: (000) 000-0000.
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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 an Australian Citizen/Permanent Resident?
*
Please Select
Yes
No
Please upload visa details & your eligibility to work
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Drag and drop files here
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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
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Employee Work Ready Details
PPE Shirt Size
*
Max distance willing to travel
*
(e.g. 30km)
What tickets do you have?
*
(e.g. White card)
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Fitness For Work
Are you taking regular medication which impacts on our ability to safety perform your role?
*
Please Select
Yes
No
(e.g. prescription medicine causing drowsiness)
Do you have any neck, spinal, head injuries or neck, back or limb disorders?
*
Please Select
Yes
No
Please provide further information
Please provide further information
Do you suffer from allergies?
*
Please Select
Yes
No
Do you have any psychiatric illness or nervous disorder?
*
Please Select
Yes
No
Please provide further information
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
Do you suffer from double vision or colour blindness or difficulty seeing?
*
Please Select
Yes
No
Please provide further information
Please provide further information
Have you ever been diagnosed with a sleeping disorder?
*
Please Select
Yes
No
Have you ever been diagnosed with heart disease, Angina or chest pains or had heart surgery?
*
Please Select
Yes
No
Please provide further information
Please provide further information
Have you ever been diagnosed with High Blood Pressure?
*
Please Select
Yes
No
Have you ever been diagnosed with Kidney disease, Diabetes or Arthritis?
*
Please Select
Yes
No
Please provide further information
Please provide further information
Have you ever had any serious injury, illness or been hospitalised for any reason?
*
Please Select
Yes
No
Have you ever lodged a Workers Compensation Claim?
*
Please Select
Yes
No
Please provide further information
Please provide further information
Have you ever suffered from deafness or had an ear operation or used a hearing aid?
*
Please Select
Yes
No
Are you currently being treated by a doctor for any illness or medical condition?
*
Please Select
Yes
No
Please provide further information
Please provide further information
Is there any reason that prevents you from wearing appropriate Personal Protective Equipment?
*
Please Select
Yes
No
Do you have a family history of any medical condition?
*
Please Select
Yes
No
Please provide further information
Please provide further information
Do you have any medical conditions needing to be monitored regularly?
*
Please Select
Yes
No
Would you be able to pass a drug and alcohol test at any time during your employment?
*
Please Select
Yes
No
Please provide further information
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
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
Have you had any exposure to hazardous or dangerous chemicals in your previous employment history?
*
Please Select
Yes
No
Please provide further information
Please provide further information
Have you had any exposure to radiation in your previous employment history?
*
Please Select
Yes
No
Have you had any exposure to dusty environments in your previous employment history?
*
Please Select
Yes
No
Please provide further information
Please provide further information
Have you undergone a hearing test in the past 12 months?
*
Please Select
Yes
No
Do you practice any fasting activities (medical or religious purposes?)
*
Please Select
Yes
No
Please provide further information
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
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Injury Management Details
Have you ever had a work related injury/illness or made a claim for Workers Compensation?
*
Please Select
Yes
No
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
END
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PAYMENT INFORMATION
Bank details for wages
Bank
*
Account Name
*
BSB
*
Account Number
*
END
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Superannuation Choice Form
Please select either 1. Your own super fund 2. Your SMSF 3. You would like us to set you up with a super fund
*
The APRA fund or retirement savings account (RSA) I nominate
The self-managed super fund (SMSF) I nominate
The super fund nominated by my employer (if this is your option, please type N/A in the boxes below)
Membership number
*
Fund Name
*
ABN
*
USI
*
Are you working on an ABN?
Yes
No
Please fill out the below.
ABN
Company Name
END
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Australian Taxation Office - Tax File Number Declaration
What is your Tax File Number
*
On what basis are you paid?
*
Please Select
Full-time employment
Part-time employment
Labour Hire
Superannuation or annuity income stream
Casual employment
Are you an Australian Resident for Tax purposes?
*
Please Select
Yes
No
Are you: (select one only)
*
Please Select
An Australian resident for tax purposes
A foreign resident for tax purposes
A working holiday maker
Do you want to claim the tax free threshold from this payer? Only claim the tax free threshold from one payer at a time, unless your total income from all sources for the financial year will be less than the tax free threshold. (answer no here if you are a foreign resident or working holiday maker, except if you are a foreign resident with a receipt of an Australian Government pension or allowance).
*
Please Select
Yes
No
Do you have a Higher Education Loan Program (HELP), Student Start up Loan (SSL) or Trade Support Loan (TSL) debt?
*
Please Select
Yes
No
Do you have a Financial Supplement debt?
*
Please Select
Yes
No
I declare that the information I have given is true and correct
*
Please Select
Yes
No
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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
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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.
*
END
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