A2A - Employment Application Form

APPLICATION FOR EMPLOYMENT

Date

First Name

Surname

Date of Birth

Do you require a Visa to work in Australia?

YESNO

Email Address

Mobile

Home Address

Home Ph

Suburb

State

Postcode

EMERGENCY CONTACT

Emergency Contact Name

Relationship

Address

Mobile

Suburb

State

Postcode

INCOME EXPECTATIONS

What are your income expectations?

Hourly Rate

Annual Salary

DETAILS OF EMPLOYMENT

Please upload your Resume / Cover letter

Browse

Do you have any upcoming commitments/pre-booked holidays?

YESNO

Give Details

Do you have a 2nd Employer / Job?

YESNO

Give Details

Are you going for other roles elsewhere?

YESNO

Give Details

Are you registered with other recruitment agencies?

YESNO

Give Details

REFEREES / REFERENCE NOMINEES

** WORK references ONLY (not family members or friends)

Must supply MINIMUM OF TWO names and companies who could speak on your behalf

Name , email address and contact details of reference 1: *

Name, email address and contact details of reference 2:

Name and contact details of reference 3:

Qualifications

Please indicate your licences/training (please provide copy/s with your application)

** Please advise your qualifications and provide certificates where possible**

Please provide details of your Qualifications

Please answer the following questions and provide details where applicable.

Have you ever had any injuries that impacted on your ability to perform work?

YESNO

Is a doctor currently treating you for any illness?

YESNO

Are you currently taking any medication?

YESNO

Have you ever spent time in hospital as a patient with a significant injury or illness?

YESNO

Are you allergic to anything including medications?

YESNO

Have you ever fractured or broken any bones?

YESNO

Have you been away from work because of illness or injury in the last 2 years?

YESNO

Have you ever received treatment for back pain or neck pain?

YESNO

Do you suffer from or have you ever suffered from RSI, tennis elbow, tenosynovitis or similar conditions?

YESNO

Do you engage in regular exercise / sports?

YESNO

Vision impairment - sight difficulties, colour blindness?

YESNO

Do you now or have you ever had any concerns with the following?

Loss of Hearing?

YESNO

Do you have any current restrictions lifting?

YESNO

Sitting / Standing for prolonged periods in one spot?

YESNO

Pushing / Pulling / Reaching?

YESNO

Do you have a fear of working at heights?

YESNO

Frequent or Migraine headaches?

YESNO

Joint injuries / conditions or stiffness? (Shoulder/Wrist/Ankle/Knee/Hips)

YESNO

Wheezing, Asthma?

YESNO

Heart trouble?

YESNO

Foot trouble, difficulty wearing shoes?

YESNO

Mental, Nervous disorders, Claustrophobia, Depressive illness, Anxiety attacks, Stress related disorders?

YESNO

Blackouts, fainting attacks?

YESNO

Fits, Epilepsy?

YESNO

Diabetes?

YESNO

Arthritis, Rheumatism?

YESNO

Dermatitis, Eczema?

YESNO

Hernia?

YESNO

If you replied YES to any of these questions please provide details

Drugs and Alcohol in the Workplace - Zero Tolerance Policy

We have a zero tolerance policy for the consumption and presence of drugs and alcohol whilst at work.

Drug and Alcohol testing will occur and is on a random basis

Do you have any concerns undergoing Drug and Alcohol testing?

YESNO

PRIVACY & PERSONAL INFORMATION CONSENT

Please complete the following consent statement

I,

consent to the collection of necessary personal information, including age, gender, medical history / reports, address details, and the disclosure of information to third parties, medical practitioners and psychological service providers.

I agree to undertake all medical tests and examinations as required to ensure my capability to perform the tasks required of the position for which I have applied.

I hereby declare that the information I have provided in this form is true and accurate and I authorise the company to verify any information if required. Any false or misleading information may result in the termination of my position / application.

I have read and understood my rights in respect of access to and collection of my personal information.

Signed

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