Application For Employment
Private & Confidential
Position applied for:
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Name
*
Prefix
First Name
Middle Name
Last Name
Date of birth:
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-
Month
-
Day
Year
Date
Address:
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number:
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Area Code
Phone Number
Mobile:
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Email:
*
example@example.com
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Current driving licence?
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Yes
No
Details of licence:
Conditions:
Licence class:
Expiry date:
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-
Month
-
Day
Year
Date
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Are there any restrictions on you taking up employment in Australia? (If yes, please provide details)
Education history
Schools:
Qualifications gained:
Colleges/universities:
Qualifications gained:
Other training:
Qualifications gained:
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Employment history
(Please complete in full your most recent employment first)
1. Name of employer:
Address of employer:
Phone number of employer:
Job title and duties:
Reason for leaving:
Notice required in current role:
2. Name of employer:
Address of employer:
Phone number of employer:
Job title and duties:
Reason for leaving:
3. Name of employer:
Address of employer:
Phone number of employer:
Job title and duties:
Reason for leaving:
4. Name of employer:
Address of employer:
Phone number of employer:
Job title and duties:
Reason for leaving:
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Current membership of professional bodies
Please note any professional bodies you are amember of or are registered with.
Other employment
Please note any other employment you would continue with if you were to be successful in obtaining this position.
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References
Please note the names and addresses of two persons from whom we may obtain both character and work experience references.
1. Name:
Prefix
First Name
Last Name
Address:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Known in the capacity of:
(i.e.Manager/Education)
2. Name:
Prefix
First Name
Last Name
Address:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Known in the capacity of:
(i.e.Manager/Education)
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Criminal record
Please note any criminal convictions. If none please state. In certain circumstances employment is dependent upon obtaining a satisfactory National Police Check and/or Working with Children Check.
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Declaration
(Please read this carefully before signing this application) 1. I confirm that the above information is complete and correct and that any false or misleading information will give my employer the right to terminate my employment without notice. 2. I agree that the employer reserves the right to require me to undergo a medical examination. I understand that should the employer require further information and wish to contact my doctor with a view to obtaining a medical report, the employer will inform me of their intention and obtain my permission prior to contacting my doctor. In addition, I agree that this information will be retained on my personnel file during employment and for up to six years thereafter. 3. I agree that should I be successful in this application, I will, if required, apply for a National Police Check and/or Working with Children Check. I understand that should I fail to do so, or should the check not be to the satisfaction of my employer, any offer of employment may be withdrawn, or my employment terminated.
Signature
Date:
*
-
Month
-
Day
Year
Date
Submit
Should be Empty: