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EMPLOYMENT APPLICATION FORM

Date

PERSONNEL DETAILS

Do you require assistance to complete this form? if Yes, please contact FIREPLUMB (07) 3064 1046
Yes
No
What is your first language?
How would you rate your reading ability in English?
How would you rate your writing ability in English?
Birthday
Will this be your primary employment?

LICENCES

Do you hold a current Drivers Licence?
Yes
No
What type of Drivers Licence do you hold?
Drivers Licence Expiry Date
Do you hold a current Forklift Licence?
Yes
No
Forklift Licence Expiry Date
Do you hold a current First Aid Certificate
Yes
No
Do you hold a current White Card?
Yes
No

MEDICAL / HEALTH

Are you currently taking prescription medicine?
Do you have any current or historic physical injuries?
Yes
No
Can you lift 20kg?
Yes
No
Do you have a current Work Cover Claim for an injury?
Yes
No
Have you ever made a Work Cover claim for an injury?
Yes
No
Do you adhere to a food/ diet plan ie religious/ allergy
Yes
No
Are you subject to Family Orders and/or AVO? If this changes during your employment please ensure this form is updated
Yes
No

Please read through the safety information

(click on yellow button) and confirm you understand




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