ENVIROGEN INDUSTRIAL SERVICES APPLICATION FOR EMPLOYMENT

Transcription

1 Applicants Name: ENVIROGEN INDUSTRIAL SERVICES APPLICATION FOR EMPLOYMENT Please complete this form online (or fill in and scan) then save it and to Please also attach your resume and copies of your licences & tickets Alternatively, post to: Envirogen Industrial Services, PO Box 1093, North Haven SA 5018 Please ensure all pages are completed (please do not write refer to resume) Office Use Only Received Date Interview Time Site / Job References Checked Medical Booked START DATE:

2 POSITION REQUESTED: DATE ABLE TO START: ENVIROGEN APPLICATION PERSONAL DETAILS First Name: Phone: Surname: Mobile: Address: DOB: Drivers Licence No: Postcode: Overalls Size: Shirt Size: Pants Size: Boot Size: Address: How did you hear about the job? Skills Summary: Qualifications Summary: Page 2 of 8

3 ENVIROGEN APPLICATION EDUCATION HISTORY School attended Date last attended Highest level achieved OTHER INFORMATION Have you worked for Envirogen previously? Do you know anyone who is currently employed by Envirogen? If yes, who? What date will you be available to commence work? Why did you leave your last employer? What most appeals to you about working for Envirogen? What least appeals to you about working for Envirogen? Page 3 of 8

4 ENVIROGEN APPLICATION CURRENT OR MOST RECENT EMPLOYER / REFERENCE Please do not write refer resume we have seen your resume and request further information below. Dates From / To Position Held Employer name & Address Supervisors Name & Telephone Reason for Leaving Do you agree for current employer to be contacted? YES: NO: PREVIOUS EMPLOYERS / REFERENCES Dates From / To Position held Employer name & address Supervisors Name & telephone Reason for Leaving Do you agree to all previous employers being contacted? YES: NO: Page 4 of 8

5 Describe your current state of health? ENVIROGEN APPLICATION MEDICAL DETAILS Have you ever suffered from any injury or condition to your back? If you ticked yes, please give details. Have you ever suffered from an injury to your Fingers, Arms, Elbows, Hands or Shoulders? If you ticked yes, please give details. Do you, or have you, ever suffered from injury to legs, knees or toes or hips? If you ticked yes, please give details. Do you, or have you, ever suffered from injury to lungs or chest? If you ticked yes, please give details. Do you, or have you, ever suffered from injury to abdomen or hernia? If you ticked yes, please give details. Have you ever suffered Face, Head, or Neck injuries? If you ticked yes, please give details. Have you ever suffered an injury or condition to your eyes? If you ticked yes, please give details. Have you ever suffered from an illness or disease to your Heart? If you ticked yes, please give details. Do you suffer any loss or impairment to your hearing? If you ticked yes, please give details. Have you ever received treatment for a Nervous Condition? If you ticked yes, please give details Have you ever suffered from Dermatitis or any other Skin Disorder? If you ticked yes, please give details. Have you ever worked in Processes or Industries, which expose you to Noise? If you ticked yes, please give details. Have you ever lost time due to work related or other injury or disease? If you ticked yes, please give details. Do you have any objection to a Pre-Work Medical Examination by a Medical Practitioner nominated by our Company? If you ticked yes, please give details Do you understand that you are responsible for organising and paying for a pre-employment drug and alcohol test (if successfully reaching that stage)? If you pass this test you will be reimbursed the cost in your first pay. Yes No Comments Page 5 of 8

6 ENVIROGEN APPLICATION ENVIROGEN CONDITIONS This job may require working remotely for periods of time. Do you have any concerns about this? It is likely you will need to travel interstate (flights, meals and accommodation provided) on projects for 2-3 weeks at any given time are you prepared to do this? (often at short notice) Are you prepared to work night shift/afternoon shift and long hours when required? Certain sites have a clean-shaven policy, are you prepared abide as required? Envirogen requires you to spend a day undergoing training and inductions on site before commencing employment. Are you happy to do this training and testing in your own time prior to assist you with gaining a position at Envirogen? Do you understand that you will often be required to work in hot, dirty, dusty and/or odorous conditions? Are you prepared to work at heights? Are you prepared to work in confined spaces (if ticketed)? Have you ever lost your driver s license? You will need to supply us with a copy of your driving record available from Transport SA Have you in the past undergone rehabilitation as a result of a work cover claim? Are you prepared to be on call 24 hours, 7 days a week and be available for call outs at short notice? Is there any further information that you wish to add? DECLARATION To the best of my knowledge all information on this application is true and complete. I understand that the company has the right to verify any information on this application and any false information will be considered sufficient cause for my rejection as an applicant or my dismissal if hired. I give Envirogen permission to conduct the relevant reference checks & obtain the required information from past employers & or other relevant parties. I understand that this will be done in an ethical and legal manner & will not compromise my current employment situation. Date of application: Applicant s signature: Page 6 of 8

7 Drivers Licence Forklift Ticket ENVIROGEN APPLICATION (Licences and tickets not accepted unless photocopy of back & front attached) Scaffolders Ticket Yes No Number Class Exp Date Trade Qualifications Name trade: Riggers Ticket EWP Dogmans Ticket Crane Drivers Ticket Welding Codes First Aid Certificate Confined Space Entry Truck Licence No. Bobcat Licence No. Scissor Lift Hydrojetting Ausjetting Vacuum Truck Other Site Inductions Page 7 of 8

8 ENVIROGEN APPLICATION MULTI-TASKING OPERATIONS Envirogen Industrial Solutions under various contracts offer clients a range of industrial services. Most often in these operations we require crews to work on tasks outside their particular trades, qualifications or skill-sets. Please fill in the following section to indicate your intention and willingness to participate in tasks outside your particular trade, qualifications or skill-sets. I am willing to work on the following tasks in addition to my core trade, qualifications or skill-sets. (Please initial in Yes or No next to each point). Trade, Qualifications or Skill-set Yes No General Labour work including shovelling, jack-hammering, manual handling. Assisting in Operation of Vacuum Trucks and all associated activities Assisting in Operation of Hydro-jets and all associated activities Grit-Blasting and all associated Activities Insulation (lagging) of plant including removal and reinstallation and all associated activities Cladding (Sheet-metal) removal and installation and all associated activities Assisting Mechanical tradesman with welding, fitting and rigging Activities Assisting Scaffolders in the erection of and dismantling of various scaffolds At Envirogen s request I will attend any training courses that will Aid me in multi-tasking. DECLARATION FOR MULTI-TASKING I understand that the aforementioned multi-tasking checklist will be heavily considered as part of my application for employment. I also understand that in the event I am offered a position with Envirogen and in turn don t participate in multi-tasking as per the aforementioned table, this will be considered a breach of my employment, and may lead to disciplinary actions including dismissal. Date of Declaration Applicant s signature: Applicant s Name: Page 8 of 8