Private & Confidential
1. Personal Details
Surname _________________________________________________________________________
Given Names ______________________________________________________________________
Address
(No.) ___________ (St.) _________________________________________________
Suburb ______________________________ Postcode ________________________
Phone number
(H) _____________________________ (W)_____________________________
Position applied for _______________________________ Location _______________________
In the course of your employment you may be required to travel to other locations.
Do you hold a current driver’s licence? (please tick)
YES
Are you an Australian citizen? (please tick)
YES
NO
NO
If you are not an Australian Citizen and if you do not have the right to permanent residency in
Australia, then:
Do you have a work permit (please tick)
YES
NO
If YES, write Visa/Passport Number: ___________________________________________________
Are you eligible for a Government Subsidy? (please tick)
YES
NO
If YES, indicate period (weeks) and amount ________________ WEEKS ______________ AMOUNT
Do you know of any reason or commitments which may interfere with your work attendance?
(eg: armed forces reserve, studies etc)
YES
NO
If YES, give details: _________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
2. Personal Details
Please indicate the times during which you are available to work.
MONDAY
TUESDAY
WEDNESDAY
THURSDAY
FRIDAY
SATURDAY
SUNDAY
START
FINISH
Are you prepared to work on Public Holidays? (please tick)
YES
NO
3. Education
Type of
Education
School/College
Name & Address
Duration of Studies
Name of Course
Level
Achieved
Secondary