Application Form

APPLICATION FOR EMPLOYMENT
Last Name:
 First Name:
Other Name(s) Initial:
Present Address: (No., Street, City, State, Code)
How Long There:
Phone
Previous Address:
How Long There:
Phone
Height:
cms
Weight:
kg
Date of Birth:
Day Mo Yr
Aust. Citizen: Citizenship if not Aust:
Yes No
Driver's License No: State: Class:
EDUCATIONAL BACKGROUND (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
Business and Personal Memberships:
EMPLOYMENT HISTORY (List last job first and account for all unemployed time)
Period
Employer
(Name & Complete Address of Firm)
Job Title and Supervisor
Salary and Reason for Leaving
Mo & Yr to Mo & Yr
Your Position
 
$ per
Name of your Supervisor
Reason for Leaving
Your Position
 
$ per
Name of your Supervisor
Reason for Leaving
Your Position
 
$ per
Name of your Supervisor
Reason for Leaving
Your Position
 
$ per
Name of your Supervisor
Reason for Leaving
Your Position
 
$ per
Name of your Supervisor
Reason for Leaving
PERSONAL REFERENCES (Two persons, not relatives or former employees, who have known you at least 1 year)
Name and Address
Occupation
Telephone
How Long Known?


 
No
Yes
Applicable details if YES
Have you ever received Workers' Compensation or Work Care Benefits or Benefits under a Sickness or Accident Policy?
Do you suffer from any serious illness, disease or disorder?
How many days have you lost because of sickness over the past two years?
Have you ever suffered a back injury?
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?
Have you ever been arrest or convicted of a crime?
Have you ever been discharged from employment?
Do you have any objection to enquiries of your present employer regarding qualifications and character?
Do you have any objection to us seeking verification and additional information to any matter within this application?
SPORT AND RECREATIONAL INTERESTS
WHAT WERE YOUR REASONS FOR APPLYING FOR THIS PARTICULAR JOB?
APPLICANTS 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 is subject to validation.
  2. I authorize the persons, schools, current employer (if approved by me in the Employment History section) and other organizations or employers named in this application to provide any relevant information that may be required to arrive at an employment decision.
  3. I understand and agree that:
    1. Any material misrepresentation or deliberate omission of a fact in my application my be justification for refusal of or if employed, termination from employment.
    2. 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 conditions of my continuing employment.
    3. A medical examination may be required, (Results will be held in confidence by us except where release of such information is required by law. Also, when certain medical restrictions relate to an individuals ability to perform a job or series of jobs, those restrictions will be communicated to Personnel or management).
Applicant's Signature
Date