Do you have any convictions for any offence/s from any court, or are you currently the subject of any charge/s pending before any court? If yes, please provide details.
If requested to do so are you willing to obtain a National Police Clearance?
Are you an Australian Citizen?
IMPORTANT: Failure to provide full and accurate information may result in the denial of any future workers’ compensation claim in accordance with Section 79 of the Workers Compensation and Injury Management Act 1981, as amended, which states: "where it is proved that the worker has, at the time of seeking or entering employment in respect of which he/she claims compensation for a disability, willfully and falsely represented themselves as not having previously suffered from disability, a dispute resolution body may in its discretion refuse to award compensation which otherwise would be payable.
Do you have any medical condition or injury that may pose a workplace risk to yourself or others?
Do you have any pre-existing medical condition or injury that will, in any way, hinder your ability to perform the tasks of the position for which you have applied? If yes, please provide details.
Are you required to take any medication that may affect or hinder your work performance?
Do you suffer from any back, neck, shoulder or knee complaints that may affect your ability to perform the duties required of the position for which you have applied?
Have you ever claimed workers’ compensation?
Are you being treated by any doctor for any medical condition or illness?
Have you been hospitalised for any illness in the last year?
Have you had a Tetanus injection in the last 10 years?
Would you be willing to undertake a medical examination if required?
Would you be willing to undertake an alcohol and other drug test if required?
Hearing a normal conversation
Reading ordinary sized print
Standing for 2 hours
Sitting for 2 hours
Lifting or bending
Repetitive movements of the hands or arms
Gripping firmly with both hands
Turning your head rapidly
Running 100 metres
Concentrating on what you are doing
Please note: allowed file types are doc, docx, odt, pages, rtf, txt & pdf and the maximum size per file is 3 MB.
I certify that the information supplied in this Employment Application is true and correct. I understand that false, misleading or non disclosure of information may result in possible disciplinary action including termination of employment.
I have read, and agree to the above declaration.