Expression of Interest - Casual Field Roles

Contact Name*

Phone*

Mobile

Email*

Address*

Address Line 2 City State / Province / Region ZIP / Postal Code Country

Do you have work rights in Australia?*

Yes
No

What class of NSW drivers licence do you hold?*

Tick below if you have a current license or certificate of the following.

If you have selected "other" above, please provide details below:

Please list any Certificates or Qualifications you have completed (e.g. TAFE Certificate, Diploma, Degree):

Are you registered with a job agency?*

Yes
No

If yes, please provide name of Agency and contact details:

Please tick the jobs you are interested in:*

Electrical
Labouring
Mechanical
Plant operation / Truck driving
Traffic control
Other

If you have selected "other" above, please provide details below:

Confidential personal medical statement: Are you aware of any condition that would, or could prevent you from fullfilling the role you seek and/or place you at any risk of aggravating an existing condition?*

Yes
No

Have you ever had problems with your back or neck?*

Yes
No

Do you have, or have you ever had a manual handling-related injury (back, neck, shoulders, knee etc)?*

Yes
No

Have you ever been exposed to excessive noise (in a previous job, at home or during recreational activities)?*

Yes
No

Have you ever had your hearing tested (Please attach a copy of the results below if available)*

Yes
No

Have you ever had trouble with wearing personal protective equipment including steel capped safety boots?*

Yes
No

Have you ever suffered from RSI, occupational overuse syndrome, tennis elbow, tenosynovitis or tendonitis?*

Yes
No

If you selected Yes to any of the above questions, please provide details below:

Do you suffer from any of the following? (please tick if applicable)

If you ticked Allergies or other tropical disease above, please provide details below:

Have you previously been immunised against Hepatitis A / Hepatitis B*

Yes
No

I understand that if I give a false answer to any of these questions, I will, if accepted for employment, be liable to dismissal without notice. I agree to undergo a medical examination, if necessary, by a Medical Officer nominated by and at Council's cost. I agree to abide by the Medical Officer's opinion as to my physical and mental ability to perform the inherent requirements of the position applied for. I am prepared to be vaccinated against any virus or disease such as Hepatitis B if my position, at any time, requires it.*

I understand

Expression of Interest – Casual Field Roles

Expression of Interest – Casual Field Roles

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Expression of interest - casual field roles

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