Casual Employment Application Casual Employment Application Form PERSONAL DETAILS Name*: D.O.B.*: Address*: P/Code*: Postal Address*: P/Code*: Telephone Number*: Mobile Number*: Email Address*: Gender: MaleFemalePrefer not to say EMPLOYMENT DETAILS Have you previously applied for work or worked for this company before?* YesNo If yes, give details: Position/s applied for: ClericalForklift OperatorSorterStacker Are you legally entitled to work in Australia?* YesNo Job network provider: Job seeker number: Current Licences and Certificates: please attach a copy eg. Forklift, First Aid, Drivers Licence Type: Type: Type: Please outline your formal education to date*: Do you have any skills that may be relevant to the job?* YesNo If yes, give details: Available to work from*: Would you be able to do weekend, shift work, or reasonable overtime?* YesNo EMPLOYMENT HISTORY Name of Employer: Position Held: Dates employed from: to: Reason for leaving: Person to contact as reference: Telephone: Name of Employer: Position Held: Dates employed from: to: Reason for leaving: Person to contact as reference: Telephone: MEDICAL DETAILS Do you have any difficulty with: Standing for a length of time?* YesNo Manual handling including lifting, squatting & twisting?* YesNo Working in dusty conditions?* YesNo Heat Tolerance (abnormal)?* YesNo Wearing protective clothing?* YesNo Working extended hours? YesNo Do you have or have had any injuries/medical conditions that might affect your ability to carry out the inherent job?* YesNo If yes, give details: Are you currently taking any prescribed medication that might affect your ability to carry out the inherent job?* YesNo If yes, give details: Have you ever had a condition that could be exacerbated by the job, including noise induced hearing loss? YesNo If yes, give details: DECLARATION BY APPLICANT I DECLARE That I agree to undergo any medical examination to determine functional capability, vision, impairment and hearing loss (at the expense of the employer) as may be requested by the employer, whether before or after commencement of employment. That if the above application for employment is accepted I will be bound and at all times observe and respect such terms and conditions of employment and such policies and rules as may from time to time be specified or stipulated by the employer. I have not suffered any injuries/medical conditions which could disable me from carrying out the job or could be exacerbated by the job. I understand that if I have given any false or misleading information it could result in there being no further work available for myself. That the answers to the questions are to the best of my knowledge true and correct in every particular. YesNo Signature*: Date*:
