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Application For Employment
Private & Confidential
Position applied for:*
Name*
Prefix First Middle Last
Date of Birth*
Date Format: MM slash DD slash YYYY
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Phone
Mobile*
Email
Enter Email Confirm Email

Are there any restrictions on you taking up employment in Australia? (If yes, please provide details)
Education history
Schools:
Colleges/universities:
Qualifications gained:
Other training:
Qualifications gained:

Current membership of professional bodies
Please note any professional bodies you are amember of or are registered with.
Other employment
Please note any other employment you would continue with if you were to be successful in obtaining this position.

References
Please note the names and addresses of two persons from whom we may obtain both character and work experience references.
1. Name
Prefix First Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Known in the capacity of:
2. Name
Prefix First Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Known in the capacity of:

Criminal Record
Please note any criminal convictions. If none please state. In certain circumstances employment is dependent upon obtaining a satisfactory National Police Check and/or Working with Children Check.*
Declaration
(Please read this carefully before signing this application) 1. I confirm that the above information is complete and correct and that any false or misleading information will give my employer the right to terminate my employment without notice. 2. I agree that the employer reserves the right to require me to undergo a medical examination. I understand that should the employer require further information and wish to contact my doctor with a view to obtaining a medical report, the employer will inform me of their intention and obtain my permission prior to contacting my doctor. In addition, I agree that this information will be retained on my personnel file during employment and for up to six years thereafter. 3. I agree that should I be successful in this application, I will, if required, apply for a National Police Check and/or Working with Children Check. I understand that should I fail to do so, or should the check not be to the satisfaction of my employer, any offer of employment may be withdrawn, or my employment terminated.
Signature
Date*
Date Format: MM slash DD slash YYYY

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