JOIN THE TEAM Join the Team Application for EmploymentHealth QuestionaireApplication for Employment Please enable JavaScript in your browser to complete this form. - Step 1 of 7Application for EmploymentPrivate & ConfidentialPosition applied for: *Name *FirstLastDate of Birth *AddressAddress Line 1Address Line 2City--- Select state ---New South WalesVictoriaQueenslandWestern AustraliaSouth AustraliaTasmaniaAustralia Capital TerritoryNorthern TerritoryState / TerritoryPostalPhone *MobileEmailEmailConfirm EmailNextDrivers Licence DetailsCurrent Drivers Licence *YesNoDetails Of LicenceConditions:Licence class:Expiry DateNextAre there any restrictions on you taking up employment in Australia? (If yes, please provide details)Education HistorySchools:College/universities:Qualifications gained:Qualifications gained:Qualifications gained: (copy)NextEmployment history(Please complete in full your most recent employment first)1. Name of employer:Address of employer: Phone number of employer:Job title and duties: Reason for leaving:2. Name of employer:Address of employer: Phone number of employer: Job title and duties: Reason for leaving:3. Name of employer: Address of employer: Phone number of employer:Job title and duties:Reason for leaving:4. Name of employer:Address of employer:Phone number of employer: Job title and duties:Reason for leaving:NextCurrent membership of professional bodiesPlease note any professional bodies you are amember of or are registered with.Other employmentPlease note any other employment you would continue with if you were to be successful in obtaining this position.NextReferencesPlease note the names and addresses of two persons from whom we may obtain both character and work experience references.1. NameFirstLastAddressAddress Line 1Address Line 2City--- Select state ---New South WalesVictoriaQueenslandWestern AustraliaSouth AustraliaTasmaniaAustralia Capital TerritoryNorthern TerritoryState / TerritoryPostalKnown in the capacity of:2. NameFirstLastAddressAddress Line 1Address Line 2City--- Select state ---New South WalesVictoriaQueenslandWestern AustraliaSouth AustraliaTasmaniaAustralia Capital TerritoryNorthern TerritoryState / TerritoryPostalKnown in the capacity of:NextCriminal RecordPlease 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.SignatureClear SignatureDate *Submit Health Questionaire Please enable JavaScript in your browser to complete this form. - Step 1 of 6HEALTH QUESTIONNAIREPRIVATE & CONFIDENTIALName *FirstLastDate *Date of Birth *Position offered: *Next(subject to satisfactory health checks) If the answer is yes to any of the questions on this form, please give full details in the space provided of the dates, duration and outcome of the illness or condition. If we have any concerns about your fitness for work, employment will be subject to satisfactory medical reports. Have you ever had?Tuberculosis, asthma, bronchitis or chestproblems? *YesNoChest pain, heart condition or raised bloodpressure? *YesNoBlackouts, fits or attacks of giddiness? *YesNoDepression, mental illness or nervous breakdown? *YesNoNextRheumatism or arthritis? *YesNoBack trouble? *YesNoTyphoid or paratyphoid? *YesNoDigestive or bowel disease? *YesNoDiabetes, thyroid or other gland trouble? *YesNoBladder or kidney trouble? *YesNoDermatitis or skin trouble? *YesNoNextVaricose veins? *YesNoAny other accident, operation or illness? *YesNoIf yes, give details:Have you any reason to believe you may be infected with any communicable disease? *YesNoNextAny other current or recent medical condition or treatment which might affect your attendance or performance at work? *YesNoIf yes, give details:Do you intend to work night duties on a regular basis? *YesNoHas any illness or medical condition prevented you from attending work on your normal duties or activities for more than one week during the past year? *YesNoIf yes, give details:NextDo you smoke? *YesNoHow many units of alcohol do you drink per week?(one unit = 1 middy beer = 1 glass wine = 1 shot of spirits) *12345Please add any additional information here.Submit
