HOPKINS TRANSPORT AUSTRALIA EMPLOYMENT APPLICATION

Transcription

1 HOPKINS TRANSPORT AUSTRALIA EMPLOYMENT APPLICATION In completing this form you should: INFORMATION FOR COMPLETING THIS FORM 1. Read and understand the requirements prior to completion 2. Complete all sections. Incomplete forms will not be processed. 3. Attach photocopies of supporting documentation such as licences and certificates to this form. Do not attach originals. If you do not have copies with you when completing this form, your application cannot be processed until you provide your copies. 4. When finished filling in the form, re-read it to ensure all sections are completed and correct. 5. Submitting this form is not an offer of employment and does not guarantee employment. 6. We may contact any of your previous employers shown on this form for the purpose of confirming your employment details and determining your suitability for employment. 7. Prior to an offer of employment, we will need to ensure that you have satisfactorily met all preemployment checks, such as the Fitness For Work Medical together with the information set out in Pt 6. Please forward this form together with copies of relevant documentation to: POST - Hopkins Transport Australia, Wirraway Street, Tamworth NSW ashley@hopkinstransport.com.au FAX - (02) SECTION 1: PERSONAL INFORMATION First Name: Preferred Name: Surname: Date of Birth: Usual Residential Address (no. and street): Suburb: State: Post Code: Home Phone: Mobile Phone: Are you an Australian resident? If not you must attach details of the visa that allows you to work in Australia Do you hold a current drivers licence: Yes / No State of Issue: Licence No: Class: Expiry Date: A copy of your driving history report, from the relevant authorities, is required for applicants applying for driving positions as well as a copy of your current driver s licence. 12/01/2017 Page 1 of 6

2 SECTION 2: EMERGENCY CONTACT INFORMATION This person must be a next of kin who can be contacted in the event of an emergency. This person cannot be your employer. The address must be their actual home address. A post office box is not acceptable. First Name: Surname: Relationship: Address (Street and No.): Suburb: Work Phone: Mobile: Home Phone: SECTION 3: EMPLOYMENT HISTORY Work History: Beginning with your current or most recent employment, please provide details of the last two years including any periods of unemployment. Important: We will contact any of your previous employers shown above for the purpose of confirming your employment details and determining your suitability for employment. May we also contact your current employer? Y/N COMPANY NAME POSITION PERIOD OF EMPLOYMENT NAME OF SUPERVISOR CONTACT DETAILS (PH) REASON FOR LEAVING 12/01/2017 Page 2 of 6

3 Driver History: Please provide details of any accidents/incidents you have been involved in for the previous five years. DATE LOCATION TYPE OF VEHICLE DETAILS OF INCIDENT (INCLUDING CAUSE OF ACCIDENT) Qualifications: TRAINING COURSE/QUALIFICATION DATE ACQUIRED Skills and Knowledge: Please list your skills and knowledge. Include things such as; what you can do, what you can operate, load restraint, risk assessments, mechanical, specialized routes you have knowledge on, wide loads etc Further Questions: What do you know about our company? 12/01/2017 Page 3 of 6

4 Why do you want this job? Is there anything you want to tell us about yourself? SECTION 4: HEALTH This information remains confidential and may assist medical personnel in any emergency if required. A disability or injury or condition is not a barrier to the consideration of an application for employment. To assist in your assessment, please complete the following (circle answer): Condition of health: Good Fair Poor Do you have a disability, injury, illness or condition that may affect any aspect of your work performance or that may be aggravated or accelerated by the type of work you are applying for: Yes No If yes, provide details: Are you currently taking any prescribed medications: Yes No If yes, provide details: Do you wear contact lenses: Yes No Have you suffered in the past, or do you currently suffer from any of the following (circle answer): Inguinal Hernia Yes No Epilepsy Yes No Heart Ailment Yes No Back Pain Yes No Diabetes Yes No Hearing Loss/Damage Sight Loss/Damage Yes No Asthma Yes No Any other disability Yes No Yes No If you suffer from either diabetes or epilepsy, is the ailment medically controlled? Yes No 12/01/2017 Page 4 of 6

5 A previous Workers Compensation claim is not a barrier to the consideration of an application for employment. To assist in assessing your application, please complete this section accurately. 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 or entering employment. Therefore, it is important that your answers are correct. Have you ever made a claim for Workers Compensation? Yes No (If Yes, please provide details below) Description of Injury or Disability Date Occurred Duration Employer SECTION 5: FITNESS FOR WORK It is important that you be medically fit to perform the duties associated with the position you are applying for (please circle answers) Do you agree to undergo a full pre-employment medical and physical assessment (including a drug and alcohol screen at the Company s expense? Yes No The Company s Fitness for Work policy includes a Drug and Alcohol policy to help ensure that employees are not affected by drugs or alcohol whilst at work. Do you agree to participate during your employment (including all aspects of drug and alcohol screening and other possible medical testing, and to disclosure of the test results by the test provider for use by the Company)? Yes No Depending on the requirements of the work, some activities may be carried out at heights. Is there any medical condition or other reason to prevent you working at heights? Yes No Do you agree to not be in possession of, under the influence of, or consume intoxicating liquor or drugs whilst working with the Company? Yes No Are you prepared to comply with all Company safety rules and procedures? Yes No Are you prepared to wear and use the correct personal protective equipment? Yes No If you are a smoker, are you prepared to comply with all Company rules which restrict smoking? Yes No 12/01/2017 Page 5 of 6

6 SECTION 6: DECLARATION Before signing the declaration below, please read the following points and clarify anything that you are unsure of with the Company s representative. 1. I understand that this is a registration of interest for employment and does not constitute an offer of employment. 2. I certify that the information set out in this form to the best of my knowledge, true and accurate. 3. I understand the Company reserves the right to verify all information and any false statements will be sufficient to cause my rejection as an applicant, my dismissal if hired, or termination of my agreement. 4. We wish to inform you that as part of your condition of employment a successful pre-employment medical assessment will be required. 5. The standard used is the relevant Assessing fitness to drive for commercial and private vehicle drivers. This may involve a pre-employment medical, including a drug & alcohol test. 6. It is a requirement to sign and abide to the company s HV Driver Position description and code of conduct. 7. A Training Needs Analysis and successful in-cab driving assessment will also be conducted. 8. A psychometric analysis for suitability may be requested. 9. Probation periods will be implemented depending on training and induction requirements. I, have read, understood and agree to the terms above. (Signature) Date: dd/mm/yyyy We appreciate you taking the time to apply for this position. You will be contacted shortly. 12/01/2017 Page 6 of 6