Application for Employment
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- Charla Carter
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1 Application for Employment This form is to be completed when seeking employment within the Meales Group and its entities. Please circle which entity and location you are seeking employment: Meales Concrete Pumping: Bundaberg Darwin Hervey Bay Gladstone Mackay Moranbah Perth Sunshine Coast MCP QLD: Brisbane Specialised Concrete Pumping: Yatala Victoria Pumpcorp: Brisbane Postcode: Phone: (H): (M): Tax File Number: Date of Birth: High Risk Work Licence : High Risk Application, i.e. Concrete Pump, Forklift etc: High Risk Licence Expiry: Construction Card : Other Competencies; ie Working At Heights, First Aid, EMP, Scissor Lift, Scaffolder, Confined Space etc Type of Competency Card :
2 Type of Competency Card : Drivers Licence : Classes: Transport Driving Record Provided: Has your drivers licence ever been endorsed, revoked or suspended? If yes, give details: TYPE OF EMPLOYMENT SEEKING: Position: FULL TIME PART TIME CASUAL Are you prepared to work overtime, including Saturday? EMPLOYMENT HISTORY: Beginning with your current or most recent employment, please provide detailed working history of at least 5 (Five) Years: We will contact any of your previous employers listed below for the purpose of confirming your employment details and deteminining your suitability for employment. May we contact your CURRENT employer? Company Telephone : Company Telephone : Ref: mcpnew/hr/hrforms/application for employment.doc Page 2 of 5 Issue: 1 14/10/13
3 Company Telephone : NEXT OF KIN (in case of any Emergency): Relationship: Contact Number(s): Relationship: Contact Number(s): MEDICAL HISTORY: The information provided in this section may be made available to an insurer in connection with any claim for workers compensation. A worker may not be eligible for compensation for an injury or disability sustained in the workplace where it is proved that the worker made willful and false representations as not having previously sustained the injury or disability at the time of seeking employment. Therefore, please provide correct answers. Have you ever made a claim for Workers Compensation? (If YES, please provide details below). Description of Injury Date Occurred Duration Employer Ref: mcpnew/hr/hrforms/application for employment.doc Page 3 of 5 Issue: 1 14/10/13
4 FITNESS FOR WORK: Are there any pre-existing ailments or medical conditions that may hinder or influence you ability to perform full duties? Please list below (ie: Dermatitis, Degenerative Spine disease, Hip replacement, Organ transplants etc) Description of medical condition Year injured or years with condition Restrictions Do you agree to undergo a full pre-employment medical assessment (including drug and alcohol screen) at the Company s expenses? Further medicals maybe required, such as Coal Board Medical and schedule Drug and Alcohol tests to support induction applications, etc. Do you agreement to undergo further medical assessments, as directed? Do you agree to not be in the possession of or under the influences of alcohol or drugs whilst at work? Is there any reason preventing you from wearing or using Personal Protective Equipment (PPE)? Do you agree to the Meales Group obtaining a History Claims report from Workcover /QCOMP? If you answered NO to the above, please provide details: I,, declare that all answers are freely given and are true to the best of my knowledge and accept that any false or misleading information may lead to my dismissal. I authorise my previous employers to release details of my employment history. Signed: (Employee) Date: Ref: mcpnew/hr/hrforms/application for employment.doc Page 4 of 5 Issue: 1 14/10/13
5 Please provide details as requested below: Pay slip PAYMENT METHODS Account BSB & Branch: Account Number: SUPERANNUATION: Name of Fund: Address of Super Fund: Phone of Super Fund: Member Number: OTHER: BERT : CIP NO: QLEAVE : OFFICE USE ONLY Commencement Date: Classification: Rate of Pay: Ref: mcpnew/hr/hrforms/application for employment.doc Page 5 of 5 Issue: 1 14/10/13
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