GL-IMS-F-25 Application for Employment

GL-IMS-F-25 Application for Employment - CONFIDENTIAL
To be completed personally by the person who is applying for the position.

Please note:

The completion of this form does not indicate that there is any obligation on the company to engage the applicant.

This information is collected for the purposes of assessing your suitability for employment at the company and to form the basis of your employee record, including changes in your employment, if you are employed by company.
Date of Application

DayMonthYear
Date
Your full name:

First NameLast Name
Pronoun
Your address:

Street Address

Street Address Line 2

CityState

Postal
Your mobile number:
Date of Birth

DayMonthYear
Date
Email address:
example@example.com
Legal Work Status

As per our obligations under the Employment Relations Act and Immigration Laws, we may require you to provide evidence of your entitlement to work and reside in Australia.
Do you have Australian Citizenship
Do you have Permanent Residency
Do you have a current work permit
Any other visa (eg.Student Visa, Working Holiday Visa) please detail
Have you worked forthis company or an associated company before?

Other
Do you have secondary employment?

Other
If you have documents for the above questions, please upload:

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Payroll Details:
Tax File Number:
Superannuation Fund:
Superannuation Number
CO-INVEST No:
Inkolink Member No (if applicable):
Upload a copy of your police check if you have one:

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Upload a copy of your working with children check:

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Referee Details:
I consent to the company seeking verbal or written communication on a confidential basis about me from representatives of my previous employers and/or referees and authorise the information sought to be released by them to the company for the purposes of ascertaining my suitability for the position for which I am applying. I understand that the information received by the company is supplied in confidence as evaluative material and will not be disclosed to me.
Name

First NameLast Name
Position

First NameLast Name
Phone Number

Area CodePhone Number
Email
example@example.com
Bank Account Details:
Bank Name:
Account Name:
BSB Number:
Account Number:
Current Medical Details
Doctors Name:
Medical Practice Name:
Medical Practice Address:

Street Address

Street Address Line 2

CityState

Postal
Medical Practice Number:

Area CodePhone Number
Medicare Number:
Have you got ambulance cover?

Other
Who have you got ambulance cover with (if yes)?
Any existing medical conditions:
Any known allergies:
List any current medication:
HEALTH & SAFETY
Have you had an injury or medical condition caused by gradual process, disease or infection, for example hearing loss, sensitivity to chemicals, respiratory problems, repetitive strain injuries, work related stress that may be aggravated or further contributed by the tasks of this job?

Other
Do you have anyhealth condition that could affect your ability to do this job?

Other
Have you ever claimed accident compensation for a work related injury/accident?

Other
GENERAL

In the event that your role requires you to work closely with community groups and the general public, you may be required to undertake a police check prior to commencing this work.
I agree to undertake a police check if requested to do so

Other
Do you have a current driver’s license?

Other
Do you give permission to conduct a license check (for points check only*)? (This is not a check on driving record.)

Other
Do you have a spouse, partner, relative or household member working at the company

Other
Emergency Information
Name of Emergency Contact:

First NameLast Name
Relationship to Emergency Contact:
Address of Emergency Contact:

Street Address

Street Address Line 2

CityState

Postal
Mobile Number:
Licence and Training Information
Upload your drivers licence - FRONT ONLY

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Upload your drivers licence - BACK ONLY

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Upload your high risk licence - FRONT ONLY

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Upload your high risk licence - BACK ONLY

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Upload your Construction Induction Card

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Upload your traffic control tickets - FRONT

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Upload your traffic control tickets - BACK

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Upload any other relevant tickets/licenses you may wish to share:

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Lastly, click on the link below to print the required documents - You need to provide this information to the admin area for processing before you commence work.
Print and Complete:

Tax Declaration Form

For your information only, do not need to print:

Fair Work Information Statement
Declaration:
I, First Name Last Name declare that to the best of my knowledge the information provided in this application and my enclosed CV or resume is accurate and I understand that if any false or misleading information is given, or any material fact suppressed, I will not be employed, or if I am employed, my employment will be terminated. I also understand that any false information given in relation to my medical history with regards to gradual process, disease or infection can result in my loss of entitlement for any compensation.
Signature Date
Please verify that you are human
Should be Empty:

GL-IMS-F-25 Application for Employment - CONFIDENTIAL

Legal Work Status

Payroll Details:

Referee Details:

Bank Account Details:

Current Medical Details

HEALTH & SAFETY

GENERAL

Emergency Information

Licence and Training Information

Lastly, click on the link below to print the required documents - You need to provide this information to the admin area for processing before you commence work.

Declaration: