Please Ensure This Form Is Completed Before Returning Your Application for Employment

HAZELWOOD

APPLICATION FOR EMPLOYMENT FORM

Please ensure this form is completed before returning your application for employment.

Your application cannot be considered further if this form is incomplete.

Position applied for: / BOILER MAKER
1. Personal Details
Given Names: / Surname:
Postal Address:
Contact Details: / Home Ph: / Business Ph:
Mobile Ph: / Email:

Where did you see this position advertised?

(please specify)
The Latrobe Valley Express / The Age / Other Newspaper / Print Media:
University Website / Noticeboard / Internet Website:
Privacy
All personal, sensitive and/or health information collected by GDF SUEZ Hazelwood, or by service providers engaged by GDF SUEZ Hazelwood, is done so in accordance with the GDF SUEZ Hazelwood Privacy Policy.
Destroy my application at the conclusion of the hiring process

HAZELWOOD

2. Education / PLEASE LIST ALL SECONDARY, POST-SECONDARY, TERTIARY & TRADE QUALIFICATIONS OBTAINED
(MOST RECENT FIRST)
Qualification / Years / School/Institution / Details (Majors, specialisations, etc)
3. Membership of Professional Associations / RELEVANT TO EMPLOYMENT
4. Employment History / PLEASE LIST YOUR LAST THREE POSITIONS, INLCUDING YOUR CURRENT POSITION (MOST RECENT FIRST)
Last / Present Position:
Employer:
Address:
Position Held: / From: / To:
Reason for Leaving:
Key Duties & Responsibilities:
4. Employment History (Continued)
Previous Position:
Employer:
Address:
Position Held: / From: / To:
Reason for Leaving:
Key Duties & Responsibilities:
Previous Position:
Employer:
Address:
Position Held: / From: / To:
Reason for Leaving:
Key Duties & Responsibilities:
Periods of Unemployment:
Dates / Reason
5. References / Please complete details of people we may contact
Name / Position / Organisation / Business Address / Phone
6. Additional Questions
§  Do you have the legal right to work in Australia? / Proof of your legal right to work in Australia may be required on offer of employment.
Yes / No
§  Do you have any convictions which are less than 10 years old and/or juvenile convictions which are less than 5 years old?
If yes, please give details: / There is no requirement to answer this question if the conviction/s have been quashed or have subsequently been pardoned.
Date / Court / Offence
§  Fitness for work
Applicants are required to undergo a medical examination by the Company’s medical practitioners as part of GDF SUEZ Hazelwood’s employment process, to ensure that they are able to safely perform the duties of the position applied for.
Please indicate any existing medical conditions or past significant illnesses, any injuries or other physical disabilities, and all Worker’s Compensation or Workcover claims. This information is necessary so that the Company’s medical practitioners can be advised prior to conducting any medical examination.
Date / Nature of Injury / Employer (if applicable) / Claim settled or ongoing
§  Proof of Identity – Documents required as evidance of Identify
To validate your identify GDF SUEZ Hazelwood requires that you provide copies of at least one of the following identification cards containing your signature and photograph:
·  Driver’s License
·  License to Perform High Risk Work
·  Passport
Declaration & Consent
I hereby declare that:
§  The information provided in this form is true and complete, and I authorise GDF SUEZ Hazelwood to verify any information I have submitted herein;
§  I consent to the collection of personal, sensitive and/or health information reasonably required to assess my suitability for the position for which I have applied, by GDF SUEZ Hazelwood and third party service providers collecting information on behalf of GDF SUEZ Hazelwood; and
§  I authorise that any personal, sensitive and/or health information collected by third party service providers during the recruitment process, may be provided to GDF SUEZ Hazelwood in order for GDF SUEZ Hazelwood to assess my suitability for the position for which I have applied.
Name (print): / Date:
Signature:

Please return this completed Application Form (together with your Resume and Key Selection Criteria) to:

Rebecca Rogers

Acting Human Resources Business Partner

GDF SUEZ Hazelwood

Via email at: