/ APPLICATION FOR EMPLOYMENT

This Document is Controlled in Printed Form

Diagnostic Services Pty Ltd & Consultant Pathology Services Pty Ltd

EMPLOYMENT APPLICATION FORM

– CONFIDENTIAL –

An equal opportunity employer

Information that will help us with your application

Selection criteria

Make a brief statement showing how you satisfy the selection criteria attached or in the advertisement. Use examples where possible.

Employment History

State brief details of your employment history. You may include temporary or part-time jobs you have worked in and experience gained in Australia or overseas. You should mention the title of the job, the period you were employed and any duties and responsibilities you had.

Referees

List the names and telephone numbers of two people who can be contacted about your applications. At least one of these people should be a recent work supervisor.

PERSONAL DETAILS
Application for employment as
Surname / Other Names
Mode of address / Mr Mrs Miss Ms Dr
Postal address
Telephone number / Date of Birth (optional)
If a non-resident, do you hold a current Australian work permit? / Yes  No 
If yes, what is your visa number?
When could you commence the employment for which you are applying?
What are your main interests, hobbies etc outside of work?
Do you have a health problem or a disability which is relevant to your job application? / Yes  No 
If yes, please describe the health problem or disability
Do you know of any reason why, if appointed, you would be unable to attend regularly to work? / Yes  No 
If so, please give details
Have you ever had a workers compensation claim? / Yes  No  / If so, please give details
Have you been convicted by a court of any criminal offences? / Yes  No  If so, please give details

EDUCATION

Education and Training
Name of school, college etc attended / Dates / Qualifications obtained
Professional or other training
Selection Criteria
Make a brief statement showing how you satisfy the selection criteria:
Additional Information
Please add here, or on a separate sheet, any additional information you wish to be considered in support
of your application and which is relevant to it.
Employment History, starting with your present or most recent employment (past 10 years)
Date
From To / Name of employer and nature of business / Position held and brief details of duties / Reason for leaving
References
Please give the names, addresses and telephone numbers of two persons as referees whom we can approach now for references, other than your current employer or relatives. We also require where possible one recent employer reference.
Unless you so request, no approach will be made to your present employer before an offer. An offer may be conditional upon receipt of a satisfactory reference from your present / most recent employer.
I do/do not want my present employer to be approached unless and until I am offered, subject to a satisfactory reference, the job for which I am applying.
Referees

Requirements for appointment to Diagnostic Services Pty Ltd & Consultant Pathology Services Pty Ltd

Criteria of Appointment

You can only be appointed to a position with the Company if:

-  you are an Australian citizen; a permanent resident of Australia or have a Visa suitable for temporary employment;

-  you provide proof of identity and other relevant documents;

-  you provide a copy of your Driving Record from the Department of Transport (Service Tasmania)

(only applicable if you are required to drive a Company vehicle in the course of your employment).

-  You provide a satisfactory criminal records check

Agreements & Undertakings

I understand that any offer of employment is based on the accuracy of statements made by me in this application and declare to the best of my knowledge and belief all information to be true and complete. I understand that any false statement is sufficient reason for rejection and termination of employment.

Privacy Principles

I have read the “protection of your privacy” principles detailed in this application and consent to the collection, use and storage of my personal and sensitive information as indicated.

Signature: ……………………………………………………… Date: …………………………

Protection of your Privacy

As part of our implementation of the National Privacy Principles we request that you read the following information about privacy and disclosure of personal information about you and sign where indicated to acknowledge your acceptance and understanding of this information.

Personal and sensitive information will be collected from you directly when you fill out and submit one of our application forms or provide any other information in connection with your application for employment with us.

“Personal information” – means information about you, including your work experience, qualifications, opinions about your work performance (e.g. references) and other information obtained by us in connection with your possible employment.

“Sensitive Information” – means more private information about you, including health or disability etc. Sensitive information can, in most cases, only be disclosed with your consent.

We may collect personal or sensitive information about you when we receive any reference about you, or you provide us with any additional information about yourself. If you wish to contact us about your personal or sensitive information in relation to this application you should contact:

Human Resource Manager

Diagnostic Services Pty Ltd

GPO Box 1535

Hobart

TAS 7001

Your personal and sensitive information may be used in connection with employment within Diagnostic Services Pty Ltd & Consultant Pathology Services Pty Ltd and may be disclosed to referees or a referees or any person with a lawful entitlement to obtain the information. If you do not provide us with the information we seek we may be limited in our ability to locate suitable work for you within the organisation. If your application for employment is unsuccessful we will destroy all personal information and sensitive information we hold about you, in line with National Privacy Principle 4.2, unless we have discussed this with you and only for the purposes of you gaining future employment with us.

You can gain access to your information to correct if it is wrong. Subject to come exemptions (for example in an employee / employer situation) that are set out in National Privacy Principles (Principle 6 Access & Correction), you have a right to see and have a copy of personal and sensitive information about you that we hold. If you are to establish that personal and sensitive information that we hold about you is not accurate, complete and up-to-date, we will take reasonable steps to correct it so that it is accurate, complete and up-to-date.

Doc Owner / Kerry Houston / Doc Approver / N / A / Doc Code / DSPL-HR-FM-0021-00 / Approval Date / N / A / Page 1 of 5