Employment Application Form

• Audit Title

• Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Instructions:
  
  1. Fill out the Employment Application Form below.
  2. Make sure to answer all questions in each section.
  3. Leave complete notes on questions that require specific details. (E.g Have you ever made a claim on Workers’ Compensation before?)
  4. Complete the form by leaving a digital signature.

PERSONAL DETAILS

• Position Applied For:

• Location:
  Address

• Surname:

• Given Name/s:

• Address:
  Address

• E-mail Address:

• Contact Telephone:

• Mobile:

• Date of Birth:

  Date

• Marital Status:

• No. of Dependents:

EMPLOYMENT HISTORY

• Have you ever had a criminal conviction?

  Yes

  No

• Please give details

• Do you have police clearance and can you provide a letter if required?

  Yes

  No

• Do you have your own transportation?

  Yes

  No

• Previous Employer

Employer

• Employer Name

• Employed From

  Date

• Employed Until

  Date

• Reason for leaving

• Have you ever made a claim on Workers’ Compensation before?

  Yes

  No

• Company Name:

• Date:

  Date

• Results:

• Preferred Working Hours (AM/PM)

• Are you prepared to work on Weekends?

  Yes

  No

• Are you prepared to work on Public Holidays?

  Yes

  No

• Are you prepared for Evening work?

  Yes

  No

ACKNOWLEDGEMENT

• I agree that all information prepared in this form is a true and accurate account of my background and experience and that if any information given is false or misleading, that I may be terminated at the sole and absolute discretion of the Company.

• Signature of Applicant

  Sign

• For Office Use

• Overall Appearance

  Pass

  Fail

• Attitude

  Pass

  Fail

• Is there CV attached?

  Yes

  No

• Is there Police Clearance attached?

  Yes

  No

• Start date

  Date

• Other Comments