Employment Application Form

This form must be completed by all applicants. All questions to be answered.

* Position Applied for:

* Todays Date:

Personal Information

* Title:

* Given Names:

* Surname:

* Date of Birth:

Country of Birth:

Time in Australia:

* Email:

* Mobile:

* Home Phone:



Select a state:

* Postcode:

Are you legally entitled to work in Australia?

Next of Kin Information

* Next of Kin:

* Relationship:

* Address:

* Postcode:

* Phone:


Please attach your current resume:

Browse:   .doc, .docx, .pdf, .zip

Cover Letter

Please attach your cover letter:

Browse:   .doc, .docx, .pdf, .zip

Or write your cover letter now:


Education 1

Education 2

Education 3

Education 4

Membership of Relevant Bodies, Associations, Unions, etc...

Current Member of:

Expiry Date:

Past Member of:

Employment History

Have you ever been employed by this company?

State when:

Reason for leaving:

Last or Present Position:

Last or Present Position 1:

Last or Present Position 2:

Last or Present Position 3:

Last or Present Position 4:

Do you have any objections to our contacting your present employer?

Past Employment:

Past Employment 1

Past Employment 2

Past Employment 3

Past Employment 4

Do you have any objections to our contacting your past employers?

Drivers Licence

* Do you have a current drivers licence?

Copy Required

* Licence Number:

* Classification of Licence:

* Have you had any accidents in the past 3 years?

Give details:

* Have you ever had your Licence suspended?

To be completed by Applicants for Drivers Positions only

Have you had experience of?

What is the maximum load you have controlled?

To be completed by Applicants who have a QLD Plant Operators certificate

Certificate Number:

Date of Issue:

Classification & Description 1

Classification & Description 2

Classification & Description 2

Please Attach:

Browse...   .doc, .docx, .pdf, .zip

Medical History

Do you have or had you had any of the following?

Any other Health Problem or Disability, please specify:

Sick Leave

Number of Days & Hours taken over the last 12 Months:

Are you agreeable to having a Health Examination as part of this Application at your own cost?

Are you agreeable to having a Drug Test as part of this Application?

Workers Compensation & Occupational Health

Workers Compensation Conditions

Are you at present receiving treatment for any condition arising from your present or previous occupation?

Please explain nature of injury / illness

Case 1

Case 2

Are you having a claim processed for a condition that is:

Covered by Workcover?

Under Common Law?

If Yes, give details:

Do you have any condition which you believe has resulted from your present or past occupations, such as?

Any other condition please specify:

Do you have a Workplace Health & Safety Induction Certificate?

Place of Issue:


Have you had a Criminal Conviction in the past 5 Years

Have you had a Criminal Conviction in the past 5 Years?

If Yes, give details:

Reference Check 1

Full Name


Email Address:

Contact Number:

Reference Check 2

Full Name:


Email Address:

Contact Number:

* Terms

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