Employment Form - Delplant

1. Applicant Details

Full Name *

Phone Number *

Email Address *

Address *

Age *

Date of Birth *

Are you an Australian Citizen? *

Yes

No

If No, please provide details of your current Visa, including expiry date. *

2. Employment Information

Are you currently employed? *

Yes

No

If yes, please provide details (Name / Address / Phone No.) *

Have you ever worked for, or applied for a position with Delplant in the past? *

Yes

No

If yes, please provide details. *

3. Drivers License

Do you have a Drivers Licence? *

Yes

No

What type of Licence? *

Manual

Auto

Licence Number *

Licence State *

Licence Expiry Date *

4. Health and Safety

Delplant has a commitment to a zero harm workplace. To do this Delplant has an obligation to ensure all workers are free from impairment from the effects of alcohol and illicit drugs.

Do you agree to undertake required pre-employment and employment drug & alcohol testing? *

Yes

No

Would you agree to under go a pre-employment medical examination and hearing test? *

Yes

No

Do you have any medical history or physical condition that may affect your performance of the inherent requirements of this job? *

Yes

No

If yes, please provide details. *

Have you ever been injured whilst at work? *

Yes

No

If yes, please provide details of injury and time absent from work? *

Have you ever lodged a claim for workcare / work accident: *

Yes

No

If yes, what injury did you sustain and how long were you off work for? *

5. Education and Experience

Highest education level? *

Do you have suitable footwear and protective clothing that you can commence with? *

Yes

No

If Yes, please list items (eg. Steel Capped Boots, Hi-Vis Jumper): *

What previous experience have you had operating machinery and equipment? *

6. Previous employment

Employment Reference 1:

Employers Company Name

Position Held

Contact Name:

Phone

Reason for Leaving

Duties Included

Employment Reference 2:

Employers Company Name

Position Held

Contact Name:

Phone

Reason for Leaving

Duties Included

Employment Reference 3:

Employers Company Name

Position Held

Contact Name:

Phone

Reason for Leaving

Duties Included

Application made following:

Referral

Enquiry

Upload your Resume and Cover Letter (optional)

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I hereby certify that the information provided on both pages is correct and complete to the best of my knowledge. I give permission for Delplant Pty Ltd to:

(1) Check the accuracy of the information provided. I acknowledge that if I have provided false and misleading information to Delplant Pty Ltd regarding (a) pre-existing injury or disease, or (b) previous employment, then I could forfeit my rights to access compensation.

I also acknowledge that failure to divulge this information may be grounds for dismissal.

(2) Carry out a police check should it be necessary.

I agree to complete required pre-employment and employment medical checks inclusive of Medical Examination, Drug and Alcohol testing.

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Application Form