Job Application & Employment Form

Given Names *

Surname *

Preferred Name

Date of Birth *

Phone

Mobile

Address *

Suburb *

State *

Postcode *

Email *

Job Seeker ID

Yes
No

Job Seeker ID No.

Job Network

Australian Resident?

Yes
No

If no, current working visa?

Yes
No

Emergency Contact Name *

Emergency Contact Number *

Emergency Contact Relationship *

Position Applying for

Industry Sector

Tickets and licences

LR Class
HR Class
MC Class
Dangerous Goods
Concrete Mixer Experience
MR Class
HC Class
B-Double Experience
Furniture Experience
Refuse (Drive Only)
Refuse Single CTL (Side Load)
Refuse Dual CTL (Side Load)
Refuse (Rear Loader)
Refuse Truck (Front Loader)
Backhoe
Bull Dozer
Grader
Road Roller
Face Shovel
Bobcat
Compactor
Frontend Loader (LL)
Frontend Load/ Backhoe (LB)
Final Trim Experience
Skid Steer Loader
Excavator (LE)
Dump Truck
Water Cart
Scraper – Open Bowl
Scraper – Elevator
Frontend Load/ Backhoe (LB)
Final Trim Experience
Skid Steer Loader
Excavator (LE)
Dump Truck
Water Cart
Scraper – Open Bowl
Scraper – Elevator
Scraper – Twin Power
Bitumen Sprayer
Forklift Ticket (LF)
Order Picking Forklift (LO)
Container Drop Forklift
Slip Sheet Forklift
4WD Forklift
Reach Forklift
Bridge & Gantry Crane (CB)
Favco/Tower Crane (CT)
Pendulum Crane
Derrick Crane (CD)
Overhead Travelling Crane
Car
Drivers Licence – Motorcycle etc.
Buses
Taxi
National Drivers Licence (HEAVY)
Maritime Security Card
Confined Space Entry Ticket
CONST. White Card

Other tickets and licences (if applicable)

Own Transport

Yes
No

Currently Employed

Yes
No

Willing to work other positions

Yes
No

Do you suffer from any allergies?

Yes
No

If yes, please provide allergy details

Do you have a medical condition that may affect the health and safety of yourself or others in the workplace?

If yes, please list your medical condition/s:

Do you have any pre existing injuries, diseases or medical conditions that could be affected in a manual labour position?

Yes
No

If yes, please provide pre-existing injury details

Ref 1 Name

Ref 1 Company

Ref 1 Title

Ref 1 Phone

Ref 1 Business Relationship

Ref 2 Name

Ref 2 Company

Ref 2 Title

Ref 2 Phone

Ref 2 Business Relationship

Ref 3 Name

Ref 3 Company

Ref 3 Title

Ref 3 Phone

Ref 3 Business Relationship

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Job Application Form

Personal Details

Emergency Contact

Application Details

Additional Information Required

Medical Information

Referees

Referee 1

Referee 2

Referee 3

Resume