Employment Application Form

Full Name:

* required

Phone:

* required

Email:

Current Address:
( No., Street, City, State, Code )
How Long There: Phone:

Previous Address:
( No., Street, City, State, Code )
How Long There: Phone:

Date of Birth : ( Day, Mo, Yr ) Height: (cms) Weight: (kgs)
Australian Citizen: Yes No Citizenship if not Australian:

Driver’s Licence No.:  State: Class:

Education ( Evidence of scholastic success may be required )
Period Level School and City Major Subjects Awards
Mo & Yr  to  Mo & Yr
Primary
Secondary
Tertiary
Business or Vocational

Employment History ( List last job first and account for all unemployment time )
Period Employer
(Name & Complete Address of Firm)
Job Title and Supervisor Salary and Reason for Leaving
Mo & Yr  to  Mo & Yr
Job Title Salary
$ per
Supervisor Reason for Leaving
Job Title Salary
$ per
Supervisor Reason for Leaving
Job Title Salary
$ per
Supervisor Reason for Leaving
Job Title Salary
$ per
Supervisor Reason for Leaving

Personal References ( Two Persons, not family or former employers, who have known you at least 1 year )
Name and Address Occupation Telephone How Long Known?
1.
2.

Have you ever received Workers’ Compensation or Work Care Benefits or Benefits under a Sickness or Accident Policy? No Yes Applicable details if Yes
Do you suffer from any serious illness, disease or disorder? No Yes Applicable details if Yes
How many days have you lost because of sickness over the past two years? Applicable details
Have you ever suffered a back injury? No Yes Applicable details if Yes
Do you have any physical condition or disability which may limit or preclude your ability to perform the particular job for which you are applying? No Yes Applicable details if Yes
Have you ever been arrested or convicted of a crime? No Yes Applicable details if Yes
Have you ever been discharged from employment? No Yes Applicable details if Yes
Do you have any objection to us seeking verification and additional information to any matter within this application? No Yes Applicable details if Yes

Sport and Recreational Interests

What are your reasons for applying for this particular job?

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APPLICANT’S AGREEMENT
PLEASE READ THE FOLLOWING STATEMENTS CAREFULLY; THEY CONSTITUTE THE CONDITIONS UNDER WHICH YOU MIGHT BE EMPLOYED.
1. The information that I have provided on this application is accurate to the best of my knowledge and subject to validation.

2. I authorize the persons, schools, current employer (if approved by me in the Employment History section) and other organisations or employers named in this application to provide any relevant information that may be required to arrive at an employment decision.

3. I understand that:

a. Any material misrepresentation or deliberate omission of fact in my application may be justification for refusal of or if employed, termination from employment.

b. Although management makes every effort to accommodate individual preferences, business needs frequently make the following conditions mandatory: overtime, shift work, a rotating work schedule and work schedules other than Monday through Friday. I understand and accept these as conditions of my continuing employment.

c. A medical examination may be required. (Results will be held in confidence by us except where the release of such information is required by law. Also, when certain medical restrictions relate to an individual’s ability to perform a job or series of jobs, those restrictions will be communicated to Personnel or Management).