Position Applied for :
Commencement Date :
FT / PT / CAS
Given Names :
Country of Birth :
Place of Birth :
Contact Nos. Work :
Post Code :
Driver’s License No :
Professional Reg. Nos. :
Please list relevant education and training you have undertaken and any certificates received.
Attach Resume :
Contact Phone :
Reason for leaving :
Do you know of any medical reason why you would not be able to perform this role?
Are you willing to undertake a medical examination?
Are you willing for us to contact your previous employers as referees?
Are you eligible to work in Australia?
Are you willing to work weekends?
Are you willing to work shifts?
Are you the subject of any criminal charge(s) still pending before a court, or have you been the subject of criminal conviction(s) or finding(s) of guilt before a Court which are not “pardoned, quashed or spent convictions” under legislation?
This facility has:
Non-smoking policy fire safety and manual handling sessions are compulsory “Relevant criminal record checks will be conducted on applicants recommended for employment”
I hereby declare that the above information is, to the best of my knowledge, true and correct. I understand that deliberately providing false or misleading information will disqualify me from consideration for the position, and will lead to my dismissal if already employed.
Applicants signature :