EMPLOYMENT APPLICATION

Full Name:
Address:
Phone:
Email Address:
Date of Birth:
Are you prepared to work a flexible or rotating roster that may incorporate?

Day

No
Afternoon No
Night No
Weekends No
Public Holidays No
Can you provide a Tax File number No
Position applied for:

EDUCATION QUALIFICATIONS

Institution:
City/Country:
Qualifications:
Completed:
 
Institution:
City/Country:
Qualifications:
Completed:
 
Institution:
City/Country:
Qualifications:
Completed:

EMPLOYMENT HISTORY

Company Name:
Position Title :
Company Address:
Start Date:
 End Date:
Responsibilities/
Achievements:
Reason for leaving
 
Company Name:
Position Title :
Company Address:
Start Date:
 End Date:
Responsibilities/
Achievements:
Reason for leaving
 
Company Name:
Position Title :
Company Address:
Start Date:
 End Date:
Responsibilities/
Achievements:
Reason for leaving

REFEREES

Contact Name:
Company Address:
Company Name:
Phone Number:
 
Contact Name:
Company Address:
Company Name:
Phone Number:
 
Contact Name:
Company Address:
Company Name:
Phone Number:

MEDICAL

To assist Amulet Security to fulfill its obligations under Occupational Health & Safety Laws, please disclose any information about injury or medical conditions you may have.

That May:

  • Prevent you from performing the inherent requirements of the position that you are applying for;
  • or May pose a risk to the health and safety of yourself, fellow employees or clients.

Do you suffer any illness that your employer should be aware of for your own protection?
eg. Epilepsy, diabetes, asthma?

No (Next Question)

Yes Please give full details

Are you aware of any physical or mental condition likely to affect the full performance of your duties in employment?

No (Next Question)

Yes Please give full details

Have you ever made any Workers Compensation Claim?

No (Next Question)

Yes Please give full details
Are you prepared to attend an examination if required?
 No

GENERAL

Current Security License Number
Expiry Date
Current Drivers License Number
Expiry Date
Current First Aid Certificate Number
Expiry Date
National Police Clearance (less than 3 months old) Yes No

 

Do you have any objections to enquiries made to your present employer, regarding qualifications and character?

No (Next Question)

Yes Please give full details

Do you have any objections to us seeking verification and additional information to any matter within this application?

No (Next Question)

Yes Please give full details
Is there any additional information you wish to give in support of your application?
© 2011 Amulet Security . ABN: 60 311 549 465.