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Australia and New Zealand Registrations

Please use this form if you are from Australia or New Zealand and you do not require a visa to work within Australia. If you require a visa to work within Australia then please complete the International Registrationsform.

Fields marked with an asterisk (*) are compulsory

PROVIDING FALSE OR MISLEADING INFORMATION ON THIS FORM IS A BREACH OF CONTRACT AND MAY LEAD TO INSTANT DISMISSAL



Personal Particulars

First Name*: Surname*: Preferred Name:
Address: Town/City: State: Post Code:
Home Phone:  or Mobile Phone*: Email*:
Date of Birth*: Marital Status: Spouse/Partner Name:

Next of Kin

Name*: Telephone*:

Have you previously spoken to one of our recruiters? If so, please choose their name*:
Have you worked for Workforce Solutions before?*
How did you hear about Workforce Solutions?

Qualifications

Trade or type of work sought*:
If you have any, what current work licences do you hold?
If you hold any welding codes, what are they?
If you hold a mineworkers health surveillance certificate/card, what number is it?
If you have ever been inducted, when was that?
Drivers licence number:
What class(es) of vehicle are you licenced to drive?
If you have any other qualifications or certificates, what are they?
Have you worked on a mine site?
Have you worked underground?
Do you have your own tools and safety gear?*

Job availability, suitability and preferences

Have you made any workers
compensation claims in the last 5 years?*
If you have made any workers compensation claims
in the last 5 years, please provide details and dates:
Do you have your own transport?
Are you a union member?
If you are a union member, which union do you belong to?
Have you have had any criminal convictions in the last 5 years?* Please provide details: 
Are you available for work now?*
Are you currently employed?*
What company are you working for now?
Position:
Period emloyed:
Brief job description:
What level of skills do you have?*
Any preferred location?
What kind of work are you interested in?

Work History
Please provide us with details of your last jobs

Job 1

 
Company Name:
Location:
Position:
Date started:
Date finished:
Brief job description:
Supervisor's Name:
Telephone number:

Job 2

 
Company Name:
Location:
Position:
Date started:
Date finished:
Brief job description:
Supervisor's Name:
Telephone number:

Job 3

 
Company Name:
Location:
Position:
Date started:
Date finished:
Brief job description:
Supervisor's Name:
Telephone number:

Health Check
Do you wear spectacles or contact lenses?  
Do you have ear problems/deafness? Please provide details: 
Do you have any mouth disorders/dental problems? Please provide details: 
Do you have fainting fit/epilepsy/severe headaches? Please provide details: 
Do you suffer from hay fever/sinusitis? Please provide details: 
Do you have any lung problems?
(Asthma, T.B., Bronchitis, breathlessness)
Please provide details: 
Do you suffer from indigestion,
ulcers, repeated diarrhoea etc.?
Please provide details: 
Do you suffer from a heart condition -
raised blood pressure, chest pains?
Please provide details: 
Do you have kidney/bladder problems? Please provide details: 
Do you have troublesome feet/bunions? Please provide details: 
Do you have varicose veins? Please provide details: 
Do you suffer from a hernia? Please provide details: 
Do you have hepatitis/diabetes? Please provide details: 
Do you have allergic reactions?
eg. bees, spiders
Please provide details: 
Do you have dermatits or another skin condition? Please provide details: 
Do you have nervous disorders or
have you had psychiatric treatment?
Please provide details: 
Have you had any operations or fractures? Please provide details: 
Do you have a knee or joint injury? Please provide details: 
Do you have back pain/back injury? Please provide details: 
Do you have any other conditions
which may affect employment?
Please provide details: 
Are you a smoker?  
Do you drink alcohol?  
Do you take regular medication? Please provide details: 
Do you exercise? If so, how often?
What was the date of your last tetanus immunisation?  
Do you have a conscientious or other
objection to medical treatment?
Please advise us of your private doctor's name,
address and phone number:
Are there any other health issues
you would like to discuss?

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