Casual Employment ApplicationCasual Employment Application Form PERSONAL DETAILSName*:Address*:P/Code*:Postal Address*:P/Code*:Telephone Number*:Mobile Number*:Email Address*:Gender:MaleFemalePrefer not to say EMPLOYMENT DETAILSHave you previously applied for work or worked for this company before?*YesNoIf yes, give details:Position/s applied for:ClericalForklift OperatorSorterStackerAre you legally entitled to work in Australia?*YesNoJob network provider:Job seeker number:Current Licences and Certificates: please attach a copy eg. Forklift, First Aid, Drivers LicenceType:Type:Type:Please outline your formal education to date*:Do you have any skills that may be relevant to the job?*YesNoIf yes, give details:Available to work from*:Would you be able to do weekend, shift work, or reasonable overtime?*YesNo EMPLOYMENT HISTORYName 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 DETAILSDo you have any difficulty with: Standing for a length of time?*YesNoManual handling including lifting, squatting & twisting?*YesNoWorking in dusty conditions?*YesNoHeat Tolerance (abnormal)?*YesNoWearing protective clothing?*YesNoWorking extended hours?YesNoDo you have or have had any injuries/medical conditions that might affect your ability to carry out the inherent job?*YesNoIf yes, give details:Are you currently taking any prescribed medication that might affect your ability to carry out the inherent job?*YesNoIf yes, give details:Have you ever had a condition that could be exacerbated by the job, including noise induced hearing loss?YesNoIf yes, give details:DECLARATION BY APPLICANT I DECLAREThat 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.YesNoSignature*: Date*:
