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Employment Application Form

Fill out the form below or click here click here to download a printable version.

All information disclosed in this application is strictly private and confidential.

Please complete all area’s of this Application in detail where requested, as this information assists us in placing you in a position that is most suitable to you and also to our Client’s requirements.

PERSONAL DETAILS

Are you an Australian Resident?

Do you hold a current drivers licence?

Are you a member of a Union?

EMERGENCY CONTACT

WORKERS COMPENSATION HISTORY

Please provide details of any work injury that involved Workers Compensation:

Date Injury Days off Work Employer Medical Clearance

Do you consent to the verification and investigation of your Worker’s Compensation History by TIS Recruitment and/or our Insurer?

Do you have any other Health concerns or Medical Conditions that you are aware of that may affect your ability to work, or that TIS Recruitment should be made aware of, as part of our Duty of Care to its Employee’s and Clients?

MEDICAL HISTORY

Do you Smoke?

Do you Drink Alcohol?

Do you Excercise

Are you Pregnant?

Have you been hospitalised for any illness/accident or medical condition?

Have you had any operations?

Do you have a Disability or Illness at present?

Have you had any time off work in the past 2 years?

Have you had any problems with your back or neck?

Have you ever suffered from blood pressure or heart problems?

Are you taking any medication at the moment?

Have you had lung problems/asthma/bronchitis?

Have you ever had fits/seizures/blackouts?

Have you ever had any joint problems/fractures?

Have you ever had mental or nervous problems?

Have you ever received treatment for a stress related condition? (ulcers, insomnia, depression, anxiety, panic attacks)

Have you ever tested positive in any workplace Drug & Alcohol screening test?

Have you ever had any repetitive strain/overuse injury?

Do you have Diabetes?

Have you ever had Tuberculosis/Pleurisy?

Have you ever had Arthritis/Rheumatism?

Have you ever had Hepatitis/Jaundice/Liver problems?

Do you have any allergies?

Do you have any skin problems? (dermatitis, eczema, psoriasis)

Have you ever had cancer or a tumour of any kind?

Do you have any eye defects? (colour blindness, sight defect)

Do you have any hearing/ear/sinus related problems?

Do you suffer from migranes or regular headaches?

Do you suffer from any health related condition that may be affected as the result of being exposed to medications, detergents or pesticides?

Do you suffer from Epilepsy?

Do you have any Difficulty with the following activities or tasks?

Working at Heights?

Standing for any period of time?

Working in Confined Spaces?

Being in crowded area’s?

Lifting anything under 20kg?

Working with noise?

Running 100 metres?

Bending or stretching?

Sitting for any period of time?

Gripping firmly with both hands?

Repetitive hand or arm movements?

Kneeling?

Turning your head?

Understanding English

Reading or Writing English?

Concentrating?

Current Tickets & Licenses

Rigging & Scaffolding

Crane

Offshore

Mobile Plant Tickets

Other

Trade Qualifications

Current Site Inductions


DECLARATION PAGE

I do solemnly declare that:

REFERENCE CHECKS

  • I give TIS Recruitment permission to conduct reference checks with those employers listed on my résumé or entered on this document.

PRE-ASSIGNMENT MEDICAL ASSESSMENT:

  • Each and every answer is true to the best of my knowledge and belief.
  • I have been advised that, under the relevant Workers compensation & Rehabilitation Act 1981, the Workers Compensation board has discretion to refuse to award compensation, which would otherwise be payable, where it is proved that the worker has at the time of seeking or accepting an assignment willfully and falsely represented him or herself as not having previously suffered from the disability the subject of the claim for compensation.
  • If TIS Recruitment assigns me to a job then I will immediately advise them of any illness, injury or workers compensation claim I have had between signing this document and the commencement of an assignment.

CLEARANCES:

Do you have any pending or previous charges or offences that may stop you from passing a police clearance or GSDU (Gold Stealing Declaration)?

Driving Charges

Drug Charges

Theft Charges

Assault Charges

EACH AND EVERY ANSWER ON THIS DOCUMENT IS TRUE TO THE BEST OF MY KNOWLEDGE AND BELIEF.

I understand that TIS Recruitment reserves the right to verify all information and that any false statements will be sufficient grounds to cause my rejection as an applicant, my dismissal if hired, or termination of my agreement or contract.

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