Careers: Dale Alcock

Careers New Homes Consultant New Homes Consultant: South West

ALL INFORMATION DISCLOSED IN THIS APPLICATION IS STRICTLY PRIVATE AND CONFIDENTIAL.

If you provide a detailed resume you need only complete the details on this application that are not included in your resume.

Resume:

POSITION SOUGHT

PERSONAL DETAILS

Surname:

Given Names:

Home Address:

Suburb:

Postcode:

Home Phone No:

Mobile:

Date of Birth:

Email:

Drivers Licence No:

Demerit Points:

Class:

Next of Kin:

Relationship:

Work / Home Phone:

Mobile:

Address:

EDUCATION / QUALIFICATIONS

Date From / Date To	Name of School / TAFE / University	Level / Qualification	Subjects Passed

EMPLOYMENT HISTORY

Are you legally entitled to work in Australia?

Yes No

Have you ever been employed under another name?

Yes No

If yes which name?

Please provide a brief list of equipment worked on:

Name & address of current Employer / Nature of Business:

Describe your current / most recent position - include all responsibilities:

PREVIOUS EMPLOMENT

Start with most recent employment (after current employment) and work backwards

Date From / Date To	Name & Address of Employer	Position Held	Reason for leaving

REFEREES

Name 3 persons (other than relatives) from who references may be sought. In defining the relationship with
applicant we are interested in determining the basis of the reference e.g supervisor, fellow worker, teacher, friend
etcetera.

Name	Company & Address	Position Held and Relationship with Applicant	Contact No

PRE-EMPLOYMENT HEALTH QUESTIONNARIE
NOTE CAREFULLY: Section 79 of the Workers' Compensation and Injury Management Act 1981 gives a dispute resolution body discretion to refuse to award compensation which would otherwise be payable where it is proved that the worker has, at the time seeking or entering employment in respect of which he claims compensation for a disability, wilfully and falsely represented himself as not having previously suffered from the disability.

1. Have you ever made a workers compensation claim, following a work accident?	Yes No
If yes provide details:

2. Do you have any medical condition that may affect your ability to undertake the duties of the role that you have applied for including undertaking all aspects of the physical work which will form part of the role (e.g. manual handing restrictions, restrictions on working at heights, use of percussion tools, eyesight restrictions, etcetera)?	Yes No
If yes provide details:

If yes, what measures could we take to enable you to undertake your duties safely and efficiently:

3. Are you taking any medication that we as employer should be made aware of in order to provide yourself a safe working environment. Such medications may include but not limited to medications for allergies, diabetes, epilepsy etcetera	Yes No
If yes provide details:

If yes, what measures could we take to enable you to undertake your duties safely and efficiently:

4. Do you have any health issues or medical condition that we should be aware of to provide you with a safe working environment (e.g. allergies, diabetes, epilepsy, etcetra)?	Yes No
If yes provide details:

If yes, what measures could we take to enable you to undertake your duties safely and efficiently:

5. Are you willing to undertake a medical examination by a Company nominated Doctor?	Yes No
6. Are you willing to undertake a drug and alcohol test?	Yes No
Note: As Part of the General Terms and Conditions of Employment all ABN employees may be required to undergo drug and alcohol testing from time to time, and prior to employment.

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