EMPLOYMENT FORM
Surname
Given Names
Date of Birth
-
Month
-
Day
Year
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Address
Suburb
State
Postcode
Postal Address (if different from above)
Phone Number
Mobile No
Marital Status
Please Select
Single
Married
De facto
Email Address
Do you identify as an Australian Aboriginal and/or Torres Strait Islander?
Please Select
Yes
No
Available Start Date
-
Month
-
Day
Year
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Employment Type
Please Select
Full time
Casual
Employment Position
Please Select
Carpenter
Labourer
Rigger
Site Manager
Leading Hand
Site Foreman
Apprentice
Experience (Years)
USI No.
Next of Kin Name
Relationship to you
Next of Kin Contact / Mobile Number
Medical Information
To help ensure your safety onsite, please inform us if you are affected by any of the following medical conditions
Do you have any medical conditions that will prevent you from being RPE Fit tested?
Please Select
Yes
No
Medical conditions- Please provide details if Yes
Allergies
Please Select
Yes
No
Allergies – Please provide details if Yes
Current Medications
Please Select
Yes
No
Current Medications – Please provide details if Yes
Medical Conditions
Please Select
Yes
No
Medical Conditions-Please Tick and provide details if Yes
Epilepsy
Diabetes
Impaired Vision
Impaired Hearing
Knee Pain
Back Pain
Shoulder Pain
Neck Pain
Provide further details- Leave blank if no Medical Conditions
Have you previously been on WorkCover
Please Select
Yes
No
Workcover – Please provide details if Yes
Qualifications / Competencies
Please attach colour copies of all certificates / licences / SOA statement of attainment
ATTACH HERE
Browse Files
Cancel
of
Driver's Licence Number
Driver's Licence Expiry Date
-
Month
-
Day
Year
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Driver's Licence Classes Held
General Construction Induction Card – Date Issued
-
Month
-
Day
Year
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General Construction Induction Card Number (White/Blue)
High Risk Work Licence Number
High Risk Work Licence Expiry Date
-
Month
-
Day
Year
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High Risk Work Licence Classes Held
List all Other Qualifications / Competencies (e.g. fit test, scissor lift, first aid, confined space)
Training / Courses
Please attach colour copies of SOA statement of attainment
ATTACH HERE
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Cancel
of
Have you completed a Certificate 3 Formwork Falsework?
Please Select
Yes
No
Have you completed a Certificate 3 Carpentry?
Please Select
Yes
No
Employment History
List the past 5 years of employment
Employment 1 – Commenced
-
Month
-
Day
Year
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Employment 1 – Finished
-
Month
-
Day
Year
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Employment 1 – Company
Employment 1 – Position
Employment 2 – Commenced
-
Month
-
Day
Year
Date Picker Icon
Employment 2 – Finished
-
Month
-
Day
Year
Date Picker Icon
Employment 2 – Company
Employment 2 – Position
Employment 3 – Commenced
-
Month
-
Day
Year
Date Picker Icon
Employment 3 – Finished
-
Month
-
Day
Year
Date Picker Icon
Employment 3 – Company
Employment 3 – Position
Employment 4 – Commenced
-
Month
-
Day
Year
Date Picker Icon
Employment 4 – Finished
-
Month
-
Day
Year
Date Picker Icon
Employment 4 – Company
Employment 4 – Position
Employment 5 – Commenced
-
Month
-
Day
Year
Date Picker Icon
Employment 5 – Finished
-
Month
-
Day
Year
Date Picker Icon
Employment 5 – Company
Employment 5 – Position
References
List 3 contactable references
Reference 1 – Name
Reference 1 – Company
Reference 1 – Position
Reference 1 – Contact Number
Reference 2 – Name
Reference 2 – Company
Reference 2 – Position
Reference 2 – Contact Number
Reference 3 – Name
Reference 3 – Company
Reference 3 – Position
Reference 3 – Contact Number
Declaration
I, the undersigned, declare that the contents of this employment application form are true and correct to the best of my knowledge.
Print Name
Signature
Date
-
Month
-
Day
Year
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Submit
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