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EMPLOYEE REGISTRATION FORM
* = Required Field
*
Name:
*
Surname:
*
Position Applying For
*
Date of Birth:
Day
1
2
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4
5
6
7
8
9
10
11
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13
14
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Month
January
Februry
March
April
May
June
July
August
September
October
November
December
Telephone No.:
*
Mobile No.:
*
Email Address.:
Address:
*
Suburb:
*
State:
*
Postcode:
Postal Address:
Postcode
*
Car:
Yes
No
*
Gender:
Male
Female
Drivers Licence No.:
EMERGENCY CONTACT
Name:
Relationship:
Contact No.:
SKILLS
Trade/s
Tickets:
*
Have you previously worked on a commercial building site?
Yes
No
*
Have you ever completed a Building and Construction Industry Safety Induction?
Yes
No
OTHER RELEVANT TICKETS
Union (if any):
Number:
Red Card:
Number:
Other Type (1):
Number:
Other Type (2):
Number:
Other Type (3):
Number:
REFERENCES
No.
Name
Company
Telephone No.
1.
2.
3.
*
Do you have any pre-existing injuries/illnesses that could impact your ability to perform work related tasks?
Yes
No
Details:
Sub-section 82 (8) of the Accident Compensation Act 1985 may apply if you fail to make a disclosure or make a false or misleading disclosure. This may effect your entitlement to compensation under this Act.
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