Human Resources Manual 1.04.01

Revision Number: 07

Date Reviewed: 22 February 2013

TITLE: APPLICATION FOR EMPLOYMENT

Please fill in this form and attach copies of any references, qualifications or other achievements. If you need helpto complete this form please ask our Daracon staff. If you are registered, your local Job Network Provider or local AES would be happy to assist you.

IMPORTANT – PRIVACY STATEMENT

Information requested within this application is needed to consider your suitability for the position applied for and for no other purpose
Ifsuccessful, this information will be kept on your personnel file and on the computer, available only to yourself and Daracon Employees requiring the information as part of your employment including your Manager(s) and Human Resources Personnel.

POSITION(S) APPLYING FOR
(e.g. labourer, administrator, engineer etc):

Title: 1.04.01 Application FormPage 1 of 6

This Replaces Rev 6 dated 19Sep 2011

Human Resources Manual 1.04.01

Revision Number: 07

Date Reviewed: 22 February 2013

PERSONAL DETAILS:

Title: / Preferred Name:
Surname: / First Names:
Address:
Suburb: / State / Post Code:
Telephone: / () / (Home) / (Mobile)
Email Address:
Date of Birth:
Are you an Australian Citizen? / Yes / No
If no, do you have a legal right to work in Australia?
(You will be asked to provide proof of your right to work) / Yes / No
In an Emergency Contact:
Name: / Relationship:
Address: / As Above (Tick) OR
Telephone: / () / (Home) / (Mobile)
() / (Work)
Optional – This information is collated for statistical reporting only.
Are you an Aboriginal or Torres Strait Islander person? / Yes / No
Do you come from a Non English speaking background? / Yes / No
EDUCATION/QUALIFICATIONS (Please produce originals for copying)
Education Level/Qualification / Date Obtained
TICKETS/CERTIFICATES OF COMPETENCY (Please produce originals for copying)
Drivers Licence Type: / Number: / Expiry Date:
Ticket/Certificate / Certificate Number / Date Obtained
TRAINING:
Have you completed the WorkCover General Induction?
No Yes If Yes Card Number: / CGI
Other training courses completed:
EMPLOYMENT HISTORY
Tell us about your work history for AT LEAST the last 5 years– start with your most recent job.
Current Employer: / Position:
Can we contact your current employer? / No Yes
Employed from: / to / Phone No: / ()
Project or Address of Employer:
Supervisor’s Name:
Reason for leaving:
Previous Employer: / Position:
Can we contact your current employer? / No Yes
Employed from: / to / Phone No: / ()
Project or Address of Employer:
Supervisor’s Name:
Reason for leaving:
EMPLOYMENT HISTORY (continued)
Previous Employer: / Position:
Can we contact your current employer? / No Yes
Employed from: / to / Phone No: / ()
Project or Address of Employer:
Supervisor’s Name:
Reason for leaving:
Previous Employer: / Position:
Can we contact your current employer? / No Yes
Employed from: / to / Phone No: / ()
Project or Address of Employer:
Supervisor’s Name:
Reason for leaving:
REFEREES
Please list at least two people you have worked for that we can contact. You can also include one non-work referee.
1. / Name:
Position: / Company:
Contact Numbers: / (Work) / (Mobile)
2. / Name:
Position: / Company:
Contact Numbers: / (Work) / (Mobile)
3. / Name:
Position: / Company:
Contact Numbers: / (Work) / (Mobile)

EXPERIENCE AND SKILLS

In which of the following have you had experience in the last five years? (Please tick ())

Total years
experience / Total years
experience
Civil Construction Worker / Landscape Gardener/Labourer
Carpenter: Formwork/Tradesman / Landscaping - Soft
Concreting / Plant identification
Demolition / Planting
Dogman / Plant Setout
General Labouring / Turf Maintenance
Grade Checking / Turfing
Pipe Laying / Propagation
Plumber / Aborculture
Rigger / Irrigation
Scaffolding / Landscaping - Hard
Steel Fixing / Carpentry
Survey / Rock Edging
Plant Operator / Sandstone
Backhoe / Brickwork
Compactor / Concreting
Crane Driver / Timber Edging
Dozer: Type: / Paved Surfaces
Dump Truck - Articulated / Sub-base preparation
Dump Truck - Rigid / Screeding and Laying
Excavator: Type: / Paving edging
Excavator – Long reach / Fencing & Retaining Walls
Grader / Dry Rock
Grader: Final Trim / Block
Loader – Track/Wheel / Sandstone
Roller / Log Wall
Scraper: Type: / Crib Wall
GPS/ATS use on plant / Timber & Brush Fencing
Quarry Worker / Foundations
Crusher – Rock/Concrete / Drainage
Pugmill / Determining Levels
Quarry Process / Install pipes/drainage
Transport Worker / Plant and Machinery
Hydromulching
B-Double / Bobcat Operation
Fuel Cart / Backhoe Operation
Hiab / Concrete Plant Worker
Low Loader / Concrete Agitator Truck
Rigid Truck / Batching
Road Sweeper / Allocating
Stemming Truck / Concrete Yard Duties (e.g. loading bins)
Tilt Tray / Client Liaison
Truck and Dog
Watercart
EXPERIENCE AND SKILLS (continued)
Fleet Maintenance / Rail Worker (continued)
Auto Electrician / Safe Working Level:_
Mechanic – Trucks / Cert Transport & Distribution / No:
Spray Painter / Track Certifier 52/53
Rail Worker / TMO or TVO
ARTC One Track card / Front End Loader Operations
RailCorp Safety Worker card / Excavator Operators (rail)
Protection Officer Level:____ / Rail Labourer
Tamper Operator / Truck Drivers Licence Class:__
Regulator Operator / Hiab
MEDICAL HISTORY: This information remains confidential and may assist medical personnel in any emergency treatment if required.
Condition of health: / Good / Fair / Poor
Do you suffer (or have you ever suffered) any medical condition or limitation that may restrict the performance of any duties?
No Yes
If Yes, describe briefly: …………………………………………………………………………………………………………………......
…………………………………………………………………………………………………………………......
Do you suffer any medical condition for which you either do, or are required to, control through Medication?
No Yes
If Yes, describe the condition and any necessary medication: …………………………………………………………………………......
......
DECLARATION
ARE YOU PREPARED TO:
Follow the company safety rules and disputes procedure? / No Yes
Work to the best of your competence and capability? / No Yes
Have a pre-employment medical, which includes a drug test? / No Yes
Follow our Smoking in the Workplace procedure? / No Yes
Wear personal protective equipment as required by the site? / No Yes
Participate in random drug and alcohol testing / No Yes

I UNDERSTAND THAT THIS IS A REGISTRATION OF INTEREST FOR EMPLOYMENT AND ISNOT AN OFFER OF EMPLOYMENT.

I DECLARE THAT ALL THE INFORMATION I HAVE PROVIDEDIN THIS FORM IS TRUE TO THE BEST OF MY KNOWLEDGE AND I UNDERSTAND I MAY BE TERMINATED IF I KNOWINGLY MAKE ANY FALSE OR MISLEADING STATEMENTS IN THIS FORM OR IN ANY FUTURE EMPLOYMENT DOCUMENTATION.

FULL NAME: ______DATE: ______

Please have someone witness your signature to confirm your application.

WITNESS: ______DATE: ______

(Print Name and Sign)

HEAD OFFICE
17 James Street Wallsend
PO Box 299
Wallsend NSW 2287
Phone: 02 49037000
Fax: 02 49511070 / SYDNEY OFFICE
182 Adderley St West
Auburn
PO Box 6145
Silverwater NSW 1811
Phone: 02 8799 2600
Fax: 02 9748 2170 / HUNTER VALLEY OFFICE
2 Kime Road
MountThorley
PO Box 225
Singleton NSW 2330
Phone: 02 65740200
Fax: 02 6574 6740 / NORTH WEST REGION OFFICE
21 Martin Road
Gunnedah
PO Box 767
Gunnedah NSW 2380
Phone: 02 6742-4977
Fax: 02 6742-4877

Title: 1.04.01 Application FormPage 1 of 6

This Replaces Rev 6 dated 19Sep 2011