ACI Labour Hire Employee Registration Form old form

Name*

First NameLast Name

Date of Birth *

Date

Mobile Phone *

Email (for payslips & group certificates)*

Address*

Suburb*

State*

Postcode *

Employee Next Of Kin - Emergency Contact

Name*

Relationship*

Contact Number*

Working Rights

Are you of Aboriginal and/or Torres Strait Islander Australian origin?*

Are you an Australian Resident /Citizen?*

If no, please upload visa details & your eligibility to work?

Third Party Permission

If you are registered with a Jobactive provider, you may be entitled to additional funds to cover any out of pocket employment costs.

Examples of out of pocket expenses may include:

· Tools for work
· Transport
· Company uniforms, PPE - Vests, hard hats, boots
· Additional Training / Upskilling
· Vaccinations and Medicals speci

Are you currently registered with a Job Active Provider?*

Examples of Jobactive providers are:

· MAX Employment
· Sarina Russo
· Tursa
· Neato
· Salvation Army Employment Plus
· Best Employment
· Help Employment
· Joblink Plus

Is the position you are undertaking:*

Is the position in a rural location? If yes, please indicate the state and suburb:

Prior to starting this position did you undertake any role where you were declaring wages: In the last 4 weeks?*

Prior to starting this position did you undertake any role where you were declaring wages in the last 12 months?*

Do you consent for your information to be passed on to relevant third parties when related to your employment?*

Employee Work Ready Details

PPE Shirt Size*

Max distance willing to travel (e.g: 30km)*

What tickets do you have *

Fitness For Work

Are you taking regular medication which impacts on our ability to safely perform your role? (e.g. prescription medicine causing drowsiness)*

Do you suffer from allergies?*

Do you have any neck, spinal, head injuries or neck, back or limb disorders?*

Do you have any psychiatric illness or nervous disorder? and if so what*

Do you suffer from double vision or colour blindness or difficulty seeing?*

Have you been absent from work due to chronic ill health or injury during the last 2 years?*

Have you ever been diagnosed with a sleep disorder?*

Have you ever been diagnosed with Heart disease, Angina or Chest pains or had Heart surgery?*

Have you ever been diagnosed with High Blood Pressure?*

Have you ever been diagnosed with Kidney disease, Diabetes, Arthritis?*

Have you ever had any serious injury,illness or been hospitalised for any reason? *

Have you ever lodged a Workers Compensation Claim?*

Have you ever suffered from deafness or had an ear operation or used a hearing aid?*

Have you ever suffered from Epileptic attacks or been diagnosed with Epilepsy?*

Are you currently being treated by a doctor for any illness or medical condition?*

Is there any reason that prevents you from wearing appropriate Personal Protective Equipment?*

Would you be able to pass a drug and alcohol test at any time during your employment?*

Do you have a family history of any medical condition?*

Do you have any medical condition needing to be monitored regularly?*

Do you have any condition that your employer needs to know to ensure your safety and fitness for work?*

Do you need to wear prescription glasses for work?*

Do you have any medical condition preventing you from performing manual handling activities?*

Do you have difficulty running 100 metres?*

Do you have difficulty walking on rough ground, kneeling, standing continuously for 2 hours or sitting continuously for 2 hours?*

Do you have difficulty crouching or squatting, lifting or bending, turning your head rapidly?*

Do you have difficulty climbing a ladder?*

Do you have difficulty using tools?*

Do you have difficulty using hand tools?*

Do you have difficulty gripping firmly with one or both hands?*

Do you have difficulty doing repetitive movements with the arms or legs?*

Do you have difficulty concentrating for lengthy periods?*

Do you have difficulty hearing a conversation in normal conditions?*

Do you have difficulty reading standard sized print or text,understanding the English language or understanding safety signs?*

Have you had any exposure to loud continuous noise, loud sudden noise or explosives in your previous employment history?*

Have you had any exposure to Asbestos in your previous employment history?*

Have you had any exposure to hazardous or dangerous chemicals in your previous employment history?*

Have you had any exposure to radiation in your previous employment history?*

Have you had any exposure to dusty environments in your previous employment history?*

Have you undergone a hearing test in the past 12 months?*

If you have undergone a hearing test and if so, were the test results within the normal range?

Do you practice any fasting activities(medical or religious purposes)?*

What is your approximate weight?*

What is your approximate height?*

Please upload a photo that can be used as an ID for you ACi profile *

Injury Management Details

Have you ever had a work related injury/illness or made a claim for Workers Compensation?*

If you selected Yes, please fill out the following

AUTHORITY TO OBTAIN MEDICAL INFORMATION

I authorise ACI Labour Hire and their employees to obtain information on my behalf relevant to workers compensation and rehabilitation that may be necessary for consideration of future Injury Management programs. I understand that all information gathered will be used inthe strictest confidence by ACI Labour Hire and is provided only to members of the injury management case team as required.*

MEDICAL ASSESSEMENTS & DRUG SCREENING

I accept that some positions will require pre-placement medical assessments and/or drug screening and if I fail either of these tests due to non-disclosure of information, I maybe required to reimburse ACI Labour Hire for any costs incurred.*

PAYMENT INFORMATION

Bank details for wages

Bank*

Account Name*

BSB*

Account number*

Superannuation Choice Form

Please select either 1. your own super fund. 2. Your SMSF. 3. You would like us to set you up with a super fund.*

The APRA fund or retirement savings account (RSA) I nominateThe self-managed super fund (SMSF) I nominateThe super fund nominated by my employer

Membership number*

Fund name*

ABN

USI

If you are working on an ABN please fill out the below if not skip to the Tax File Declaration section

ABN

Company Name

Australian Taxation Office - Tax File Number Declaration

What is your Tax File Number?*

On what basis are you paid? (Select only one.)*

Are you an Australian Resident for Tax Purposes?*

Are you: (select one only)*

Do you want to claim the tax free threshold from this payer? Only claim the tax free threshold from one payer at a time, unless your total income from all sources for the financial year will be less than the tax free threshold. (answer no here if you are a foreign resident or working holiday maker, except if you are a foreign resident in receipt of an Australian Government pension or allowance).*

Do you want to claim the seniors and pensioners tax offset by reducing the amount withheld from payments made to you?

Do you have a Higher Education Loan Program (HELP), Student Start up Loan (SSL) or Trade Support Loan (TSL) debt?*

Do you have a Financial Supplement debt?*

I declare that the information I have given is true and correct.*

Privacy Policy

ACI Privacy Policy

I declare that I have read and understood the ACI Privacy Policy.*

Fair Work Statement

View the Fair Work Statement

I declare that I have read and understood the Fair Work Information Statement.*

Candidate Declaration

I agree to employment with ACI Labour Hire on the terms and conditions set out in this employment contract, and agree that by commencing employment I have accepted the details outlined in my Assignment Confirmation for that assignment. *

I declare that the information I have given is true and correct.*

Please sign to declare that the information you have given is true and correct.