Employment Application


THIS APPLICATION IS NOT AN EMPLOYMENT CONTRACT but merely is intended to evaluate suitability for employment. It is the policy of the company to provide equal employment to all qualified persons without discrimination on the basis of sex, race, color, religion, age, national origin, citizenship, disability, veteran status, or any other status protected under local, state or federal law. It is also the policy of the company to have the option of conducting pre-employment screening before a job offer is made. If a job offer is made, employment may be contingent upon the successful completion of a pre-employment drug screening and/or medical examination. This application will remain active for 3 years.
Referral Select Referral Method: 
Job Posting Select Posting to Apply for: 
Personal Information
Addresses
Street* City* State* Postcode* Since (Mo/Yr)* To (Mo/Yr)
Current Address *
Prior Address
Education
School Attended City State Diploma Degree/Cert. Area of Study
High School
HSC / VCE
Undergrad School
Grad School
Other School
Employment Information
Position Applied For Date You Can Start
 (yyyy-mm-dd)
Do You Prefer Can you work  Weekends
 Evenings
Available: M Tu W Th F Sa Su
Are you available for shift work?
Not Available
Please answer all of the following questions.
1. Are you an Australian Citizen / Permanent Resident?
If no, do you have a working visa? (Note: to be eligible for employment, applicants must have the appropriate work visa or have permanent residency status)
2. Do you require any special arrangements at an interview?
If yes, please provide details:
3. In the last 10 years, have you lived overseas for longer than 12 months?
4. Do you have any friends, relatives or acquaintances working for or attending the Organisation?
If yes, please exlain.
5. Have you ever applied to or worked for the Organisation previously?
6. Do you have a current First Aid certificate?
If yes, date of issue:
7. Do you have a current Working With Children Check (Employment)
If yes, license number:
8. Do you have a current Police Check?
if yes, date of issue:
9. Do you have a current International Police Check?
if yes, date of issue:
Employment History
Are you currently employed?
May we contact your present employer?
Most Recent Employer Prior Employer Prior Employer
Employer
City
State
Postcode
Phone
Position Held
From (m/yyyy)
To (m/yyyy)
Pay upon leaving
Supervisor
Duties
Reason For Leaving
Job-related Skills
Please answer the following questions if the position you are applying for requires driving a motor vehicle
1. Do you hold a Victorian Manual Drivers Licence?
If yes, Driver's License Number
Expiry Date:
2. Do you have any convictions, finding of guilt and/or pending police investigations or charges against you that are less than 10 years old? (Note: A satisfactory police record check is a prerequisite of the position)
If yes, please explain...
3. Do you have any pre-existing injury or disease of which you are aware that you could reasonably be expected to foresee, could be affected by the nature of the duties and responsibilities of the position for which you are applying? (Note: Failure to make such a disclosure or the making of a false or misleading disclosure forfeits you the right to compensation under the Accident Compensation Act 1985)
If yes, please provide a brief description (or on a separate advice):
4. Please use this space to list any special skills you may have that relate to the position applied for
5. Please list any professional licenses, designations, certifications, etc. that may relate to the position applied for. Include date granted, name of organization, and any other relevant information.
References: Two referees are required. These referees should be your immediate supervisor in your past or existing role
Reference (1) Reference (2)
Name
Address
Telephone
Relationship
Years Acquainted
Resume (Text Version)
Copy and Paste a text version of your resume here.
Upload File
Attach a file to your application submission (Permitted File Types: doc,docx,pdf,txt - Max file size: 1045876 bytes)
Applicant Certification Agreement
1. I hereby certify that the above information is correct and complete to the best of my knowledge and belief. I understand that, if I am employed, I will be liable to dismissal if any of the statements in my application are found to be deliberately misleading.
Security Code
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Type Name in Signature Box*: Date: 20-11-2017 16:52:38