Employment Application Formnetplanet2021-06-15T09:07:05+10:00 Employment Application Form Step 1 of 3 - Personal Details 33% Name(Required) First Name Last Name Address Street Address City State / Province / Region ZIP / Postal Code Date of Birth(Required) DD dash MM dash YYYY Place of Birth Address * Street Address City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Mobile(Required)TelephoneEmail Tax File Number(Required) Next of Kin Name(Required) First Name Last Name Next of Kin Relationship Next of Kin Address Street Address City State / Province / Region ZIP / Postal Code Bank Bank Address Street Address City State / Province / Region ZIP / Postal Code BSB Number Account Number Account Name Full Name on Passport Nationality Passport Number Issue Date DD dash MM dash YYYY Expiry Date DD dash MM dash YYYY Visa Number Do you require a Visa to work in AustraliaYesNoNot SurePlease supply a copy of your Passport and Visa Drop files here or Select files Max. file size: 128 MB. Describe any drug sensitivity or allergies you may haveDoctor Name First Name Last Name Describe your current medical conditionList prescription and non-prescription medication you are takingHave you ever had or been told you have/had any of the following? Lung Disorder High Blood Pressure Heart Trouble Nervous Disorder Disease or Disorder of the Digestive Tract Any form of Cancer Kidney Disease Diabetes Arthritis Hepatitis Malaria Blood Disorder If so - please describeAny Physical Injury or Deformity?(Required) Yes No If so - please describe your Physical Injury or DeformityAny Hearing or Vision Loss?(Required) Yes No If so - please describeAny Life-Threatening Conditions(Required) Yes No If so - please describeAny Back Problems(Required) Yes No If so - please describeAny Special Medical Information(Required) Yes No If so - please describeHave you been treated by a doctor/physician or been hospitalised during the past 12 months?(Required) Yes No If so - please describeHave you ever had a Worker's Compensation Claim?(Required) Yes No If so - please describeAre you prepared to work day & night shift? Day Shift only Night Shift only Both Do you have a current first aid certificate?(Required) Yes No List any Qualifications(Required)Please supply copies of Qualifications Drop files here or Select files Max. file size: 128 MB. Are you willing to undergo a Police Clearance Check(Required) Yes No Are you willing to undergo a Working with Children Check(Required) Yes No Are you willing to undergo a Driving Record Check(Required) Yes No License Number(Required) License Type(Required) Expiry Date(Required) DD dash MM dash YYYY Class(Required) State of Issue(Required)NSWACTQLDVICSAWANTTASHave you recieved a Speeding fine in the past 3 years?(Required) Yes No Any accidents where you were driving in the past 3 years?(Required) Yes No Were you the driver at fault on any occasion?(Required) Yes No Consent(Required) I understand All information will be on a private and confidential basis & training is provided in line with company policy?HiddenDate of Submission(Required) DD dash MM dash YYYY Captcha
