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Project you are applying for |
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Personal Details |
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Surname* |
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Given names* |
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Title* |
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Residential Address |
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Street/Unit No.* |
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Suburb/Town* |
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State* |
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Postcode* |
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Best Contact Phone Number 1* |
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Best Contact Phone Number 2* |
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Email address* |
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Date of birth* |
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Medical / Health Assessment |
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Measurement of your waist* |
Note: Measure your waist in centimetres just above the belly button
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Measurement of your hips* |
Note: Measure your hips in centimetres at the widest part of your buttocks
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Weight* |
Note: Please specify in kilograms
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Height* |
Note: Please specify in meters
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For the purpose of drug testing, are you or have you in the past 2 weeks taken any medication either prescribed or over the counter drugs?* |
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If yes, please describe the drug |
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Are you being treated by a doctor for any illness?* |
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If yes, please provide details |
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Have you had any operations which could affect your ability to work?* |
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If yes, please provide details |
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Have you been immunized against tetanus?* |
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If yes, please provide the date of your last immunization |
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Do you or have you ever suffered from Wheezing, Bronchitis, Asthma* |
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Do you or have you ever suffered from Diabetes* |
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Do you or have you ever suffered from Stomach pain or Ulcers* |
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Do you or have you ever suffered from Excessive noise exposure / Loss of hearing* |
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Do you or have you ever suffered from Skin disorder, Dermatitis, Skin cancer* |
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Do you or have you ever suffered from Eyesight disorders, Color blindness* |
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Do you or have you ever suffered from Blood pressure or Heart disease* |
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Do you or have you ever suffered from Head injury or Concussion* |
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Do you or have you ever suffered from Chronic ear infection* |
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Do you need to wear prescription glasses or contact lenses* |
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If yes to any of the above please provide details |
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Alergies |
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Do you or have you previously had any allergies?* |
Ie. Bee stings, Food
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If yes, please provide details |
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General Ailments |
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Do you now have or have you ever suffered from, trouble with your Back / Neck* |
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Do you now have or have you ever suffered from, trouble with your Wrists / Elbows* |
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Do you now have or have you ever suffered from, trouble with your Feet / Hands* |
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Do you now have or have you ever suffered from, trouble with your Ankles / Knees* |
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If yes to any of the above, please provide details |
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Serious injuries at work |
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Have you ever seriously injured yourself at work or suffer from industrial disease?* |
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Did any workers compensation claims result?* |
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If Yes to either the above 2 questions, please give details including rehabilitation provided |
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General questions |
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Why are you best suited for this position and if given this opportunity will you complete the project? Give an example* |
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What motivates you in a work environment? Give example including the outcome* |
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How have you coped when your work has been constructively criticized? Give example including the outcome* |
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What gives you the greatest satisfaction at work? Give example including the outcome* |
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What was the most difficult work situation you have had to face and how you tackled it? Give example including the outcome* |
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What is your approach to working in dirty, hot, uncomfortable environment? Give example including the outcome* |
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What things frustrate you the most and how do you cope with them? Give example including the outcome* |
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Have you had to deal with conflicting deadlines? How did you decide which task is to be complete? Give example including the outcome* |
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What do you expect from Siteforce as the employing company?* |
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Tell us about yourself. Life focuses/goals?* |
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Tell us about your hobbies and interests* |
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Work History |
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Note: List your last 3 to 5 places of employment with contactable references |
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Once your registration is received, Siteforce understands you have given permission to contact your references |
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Qualifications |
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Trade Certificate Type |
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Only check boxes if you have current and up to date licenses/tickets |
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Other |
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Miscellaneous |
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How did you hear about us |
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Terms and Conditions & Privacy Statement |
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Note: Any existing or historical ailments or injuries will not automatically disqualify the applicant from employment consideration.
Ailments or injuries will be individually assessed to determine:
- Applicants "fitness for purpose" and suitability for the type of work required
- The aids and/or safety measures required to assist the employee to fulfill His or Her duties
The answers given are true and correct to the best of my knowledge.
I am aware that any false or misleading statements may threaten my appointment or continued employment.
I agree to the use of the information contained within the Medical / Health Assessment for determining the suitability for the position for which I am being considered for employment.
I am aware that I may be required to seek professional assessment of any conditions stated in the questions above, certificates and or statements from previous heath assessors may be submitted if required.
I understand that I will be required to undergo periodical drug screen and alcohol breath test as a part of Mine Site, Construction Site and Siteforce Australia Testing Programs and Policies.
Privacy Statement: The personal information you provide on this form is protected by the Privacy and Personal Information Protection Act 1998. Access to the information that you provide on this form is only available to yourself and those persons authorized to access this information in the course of their duties at Siteforce Australia.
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I agree to the above terms and conditions? |
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