Employment Form - Allied Integrated Management

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Prefix

First Name

Middle Name

Last Name

Address

City

State

Postcode

Date Of Birth

Mobile Number

Phone Number

Company Applied For

Resume/CV

Drivers Licence Details

Do you have a current driving licence?

Yes No

Background Info

Are you an Australian Citizen?

Yes No

Are you of Aboriginal or Torres Straight Island decent?

Yes No

Are there any restrictions on you taking up employment in Australia?

Yes No

Are you prepared to undergo drug and alcohol testing?

Yes No

health Info

Do you have any pre -existing medical condition or injuries that would prevent you from undertaking Traffic Control duties such as standing, lifting, bending?

Yes No

Are you currently taking any prescribed medication?

Yes No

Have you ever been injured at work and made a worker’s compensation claim?

Yes No

Health Questionnaire

Please read and answer each question honestly, failure to advise Allroad Group of a pre-existing injury or medical condition may place you at increased risk of injury and may remove your entitlement to claim compensation under Workers Compensation or Accident Compensation Legislation.

Next Of Kin Details

First Name

Last Name

Relationship

Phone(Landline)

Phone(Mobile)

Address

Criminal Record

In certain circumstances, employment is dependent upon obtaining a satisfactory National Police Check and/or Working with Children Check.

Do you have any criminal convictions?

Yes No

Education

Please list your education history

Traffic Control Qualifications

Check the qualifications you currently have:

Have you had any on the job traffic control experience?

Yes No

How many years of traffic control experience do you have?

Employment Info

Are you a member or registered with any professional bodies?

Yes No

Is there any other employment you would continue if you were to be successful in obtaining this position?

Yes No

If currently employed, do you need to give a notice period?

Yes No

Employment History

Please complete your most recent employment first.

Name of most recent or current employer

Address of most recent or current employer

Job title and duties

Reason for leaving

Other Employers Information

References

Please note the names and addresses of two persons from whom we may obtain both character and work experience references.

Reference 1

Name

Phone

Known In the Capacity Of

Reference 2

Name

Phone

Known In the Capacity Of

Employee Declaration

I confirm that the above information is complete and correct and that any false or misleading information will give my employer the right to terminate my employment without notice.

I agree that the employer reserves the right to require me to undergo a medical examination. I understand that should the employer require further information and wish to contact my doctor with a view to obtaining a medical report, the employer will inform me of their intention and obtain my permission prior to contacting my doctor. In addition, I agree that this information will be retained on my personnel file during employment and for up to six years thereafter.

I agree that should I be successful in this application, I will, if required, apply for a National Police Check and/or Working with Children Check. I understand that should I fail to do so, or should the check not be to the satisfaction of my employer, any offer of employment may be withdrawn, or my employment terminated. Confirm 4*

All applicants will be subject to pre-employment drug and alcohol screening.

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Allied Integrated Management acknowledges the traditional owners and custodians of the land on which we meet and work
Master Licenses: NSW M/ L: 000101885, ACT M/L #: 17502515, WA M/L #: CA 571688, SA M/L #: 298 888, QLD M/L #: 4184168, VIC M/L # : 940 769 50S, NT M/L # : SFL1098, TAS M/L # : 261 134 969