Employment - Westkon

Thank you for your interest in joining our team at Westkon. To be considered, you must complete all sections of this application form and submit it online. The information you provide, along with your personal interview, will be used to assess your suitability for the role.

Important Note: This company is an Equal Employment Opportunity (EEO) employer and does not discriminate against any current or prospective employee. We are committed to fair and equitable treatment throughout the recruitment process. If you believe that at any stage this company or a representative of this company has discriminated against you, we encourage you to seek appropriate legal advice.

We appreciate the time you take to provide accurate information and look forward to reviewing your application.

EMPLOYMENT APPLICATION FORM
Private and Confidential

Position applying for *

How did you find out about this position? *

List your qualifications related to this position and any relevant certificates, diplomas or other. *0 / 100

Briefly list your skills relating to this position *0 / 100

PERSONAL DETAILS

Surname *

Given name(s) *

Street address *

Suburb *

Postcode *

State

Duration at present address *

Marital Status

Date of birth *

Day

Month

Year

Country of birth *

Home phone

Mobile phone *

Email Address *

Driver’s licence number

Type

Are you of Aboriginal or Torres Strait Islander *YesNo

INDUSTRY TICKETS

IF APPLICABLE

C+Bus Number

Incolink Number

Leaveplus Number (Formally Known As Co-Invest)

Construction Induction Card Number (White Card)

Other cards (please specify)

NEXT OF KIN OR CONTACT PERSON

IN CASE OF INJURY OR ILLNESS. OPTIONAL.

Contact Name

Mobile No

Street Address

Suburb

Postcode

State

Relationship to you

HAVE YOU RECEIVED ANY INSTRUCTION IN OR OBTAINED ANY OF THE FOLLOWING?

Courses

Explosive power tools *YesNo

Scaffold *YesNo

Height safety awareness *YesNo

Occupational health and safety *YesNo

Elevated work platforms *YesNo

Safety induction *YesNo

Other courses

Tickets

Dogman *YesNo

Forklift *YesNo

Vehicle loading crane *YesNo

Limited height scaffold *YesNo

First aid *YesNo

Other tickets

EMPLOYMENT HISTORY

Current Employment

Company name *

Company address

Phone No *

Start date

Position held *

Reason for leaving

Past Employment

Company name *

Company address

Contact person *

Phone No *

Position held *

Start & finish dates *

Do you have any objection to us contacting past employers? *YesNo

Please note: This information will be kept strictly confidential for use by the Human Resources department only. Under company policy, a pre-employment medical may be required if your application is successful.

PRE-EMPLOYMENT APPLICATION / QUESTIONNAIRE

Pre-employment application/questionnaire as per Occupational Health and Safety Programme & Procedures.

In accordance with our Occupational Health and Safety Policy you may be required to attend a pre-placement medical examination which will include a clinical questionnaire and full medical examination appropriate to the type of work which you will be required to undertake. The pre-placement medical examination will enable the doctor to advise on the safety with which you can carry out the specific work for which you have applied and to medically assess any pre-existing injury or disease which may be affected by your work therefore minimising any potential for the injury or disease to re occur or deteriorate further.

Please note, you are required pursuant to Section 82 (7) and (8) of the Accident Compensation Act 1985 to disclose any pre-existing injury or disease. If you do not disclose this information, you may not be entitled to Work Cover compensation for that particular injury or disease.

WORKCOVER & OCCUPATIONAL HEALTH DETAILS

NOTE: ALL QUESTIONS MUST BE ANSWERED:

1. Have you ever had a Worker’s Compensation Work Cover claim? *YesNo

Nature of injury

Date of injury

Time lost (weeks/days)

Name and address of employer at time of injury

2. Are you at present receiving treatment for any condition arising from your involvement in:

a) Your present or previous employment(s)? *YesNo

b) Your sporting / hobby activity? *YesNo

Please specify

3. Are you having (or have you ever had) a claim processed for a condition?

a) Covered by Work Cover? *YesNo

b) Under common law? *YesNo

c) Motor vehicle accident (TAC)? *YesNo

4. Have you ever received a lump sum settlement relating to any claim in Question 3? *YesNo

5. Do you have any conditions which you believe has resulted from present or past employment such as:

a) Noise induced hearing loss *YesNo

b) Back complaint *YesNo

c) Joint complaint *YesNo

d) Stress *YesNo

e) Other (please specify) *YesNo

Other conditions

TO ASSIST US WITH ARRANGING A MEDICAL EXAMINATION, PLEASE COMPLETE THE FOLLOWING:

MEDICAL HISTORY

1. Do you have any pre-existing physical condition or disease of which we need to be aware of? *YesNo

Please provide details

2. Are you aware of any pre-existing medical or degenerative condition we need to be aware of? *YesNo

Please provide details

3. Have you ever, in the course of your previous employment sustained an injury to your neck, spine, back, hips, shoulders, arms or legs? *YesNo

Please provide details

DECLARATION AND CONSENT

Name

Date *