Career Application Form

Applying for Employment as:

Title

Given Names

Surname

Email Address

Telephone Number

Mobile Number

Date of Birth

Do you have a current Drivers Licence?

If Yes, What Class?

Employer

Position Held

Status

Notice Period/Availability

Do you have a pre-existing injury or medical condition that would affect your ability to do the job you are applying for?

If so, can you provide details of the injury/medical condition or disability, and any current restrictions it may have on your ability to the work?

Are there any ways that we might be able to reasonably accommodate your restrictions that would enable you to do the type of work you are applying for?

Have you ever claimed Workers Compensation for an Injury that is relevant to the position you are applying for in this application?

If so, when and what type of injury?

Do you have current Workers Compensation claims pending?

Do you smoke?

Do you drink alcohol?

Are you taking prescription drugs?

If yes, please list

Your employment is conditional on you being free of illegal drugs. Have you taken illegal drugs in the past six (6) months?

Are you willing to undergo such an examination?

Do you know of any reason why, if appointed, you would be unable to fulfill the requirements of the position and attend work reliably and punctually?

If yes, please give details

Dates

Secondary Education

Qualifications Obtained

Dates

Technical Education

Qualifications Obtained

Dates

University Education

Qualifications Obtained

Dates

Professional or Other Training

Qualifications Obtained

NOTE: please scan and attach details of further education if necessary.

Dates

Employer and Type of Business

Position Held

Reason for Leaving

What are your main interests, hobbies, etc., outside of work?

What value would you expect to add to our company if we were to employ you?

Reference 1 Name

Reference 1 Address

Reference 1 Contact No.

Reference 2 Name

Reference 2 Address

Reference 2 Contact No.

Reference 3 Name

Reference 3 Address

Reference 3 Contact No.

* I do / do not want my present employer to be approached for reference before offer of employment is made to me.

I understand that any false or misleading information given in this application may render my contract of employment, if I am appointed, liable to termination. I declare that to the best of my knowledge the above information and that submitted in any accompanying document(s) is true and correct. I understand that you may be contacting my referees for a detailed reference.

Byrne Trailer Employment Application Form

PERSONAL DETAILS

CURRENT EMPLOYMENT DETAILS

MEDICAL HISTORY

EDUCATION AND TRAINING

EMPLOYMENT HISTORY (starting with your present or most recent employment)

INFORMATION ABOUT YOU

REFERENCES