:::: Employee Application For Employment ::::
   Position
Note: All information given on this form will remain confidential in accordance Privacy Act 1988 (Cwlth) as amended by the privacy Amendment (Private Sector) Act 2000 and the National Principles (NPP’s) which are set out in the Act. Information Privacy Act 2000 (State) and Health Records Act 2000(State).
Position Applied For:

   Personal Details - You must fill in the fields marked with a *
Title:
*Name:
*Surname:
Address:
*Phone:
Mobile:
*Email address:
*Confirm email address:
Date of Birth (optional):

Are you legally able to work in Australia? Yes No
Are you registered with Centrelink? Yes No
Are you registered with a Job Network Provider? Yes No
If yes please name provider:  
Job Search ID No:  
   Education and Training
Name of Secondary School:
Dates:
Qualifications attained: Year Completed:
Subjects Studied:

   Further Education
Post Secondary:
 Year Completed:
Trade:
 Year Completed:
Traineeship:
 Year Completed:
Professional or other training or qualifications:
 Year Completed:
Do you speak any language other than English?
Yes No
If "YES" state language:

   Licenses Currently Held
M'cycle
Taxi
Car
Fork Lift
Light Truck
Skid Steer
Medium Truck
Chemical
Heavy Truck
Security
Articulated
Excavator
Combination
Chainsaw
Bus
First Aid
Others, please specify:

  Employment History / Work Experience
Dates
Employer
Job Title
Tasks / Duties

Medical History, Health & Fitness
Pursuant toS.82 (7) & (8) of the Accident Compensation Act which came into effect on 29 June 1998, you are required to disclose to a prospective employer any pre-existing injury or disease that you have suffered of which you are aware and could reasonably expect to foresee could be affected by the nature of proposed employment being applied for.
Do you know of any medical reason why, if appointed, you would be unable to carry out the full requirements of any position applied for? If so please give details:
Are there any reasonable action this employer could take to accommodate the issues outlined above, so that you would be able to safely perform the job (eg., reasonable modifications to work stations, work equipment or work conditions)?
Do you have any pre-existing illness or injury, which could be affected by the work duties as described in the job application?
We advise that failure to make a disclosure, making a false or misleading disclosure, would disentitle you to compensation pursuant to the Accident Compensation Act should you suffer any recurrence, aggravation, acceleration exacerbation or deterioration of a pre-existing injury or disease arising from the course of or due to the nature of employment with or through Cartwright McCallum Enterprises Pty Ltd. or Indeed, Our Companies. will rely on any failure to disclose in accordance with the provisions of the Accident Compensation Act as grounds for denying compensation in accordance with S.82 (7) & (8)

   Reference Checks
Please give names, postal address and telephone numbers of three persons as referees who we can approach now for references, other than present employer or relatives. Unless you request, no approach will be made to your present employer before an offer of employment is made, in which case the offer may be conditional on receipt of a satisfactory reference from your present employer.

I do/not want my present employer to be approached unless I am offered, subject to a satisfactory reference, the job for which I am applying.
Referees
Name
Address
Contact Number

I confirm the above referees have been contacted by me and have consented to acting as a referee on my behalf. I understand that failure to gain consent of the persons listed above and to act as referees may result in Cartwright McCallum Enterprises Pty Ltd not being able to source employment on my behalf, or withdrawing or limiting future employment assistance OR Cartwright McCallum Enterprises Pty Ltd not considering me for employment.

I further understand that only information which may assist me gain employment or assess my suitability for employment will be sought from the referees, and that such information will be handled in accordance with Victorian Group Training Co Ltd Privacy Policy, including the provision of access to that information.

I understand that any false or misleading information given in this application may render my contract of employment, if I am appointed, liable to termination. I declare that to the best of my knowledge the above information, and that submitted in any accompany document(s), is correct.

   
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