Personal details
First name: Last name:
Preferred name:
Address:
Telephone Daytime: Mobile:
Email:
Employment Desired
Position:
Desired Salary: Date you can start:
Are you employed now: If so, can we contact present employer:
Ever applied to company before: When:
What type of work are you
available for? (tick one) Full time Part time Casual
General Information
Qualification title Institution/training provider Year completed
Are you currently undertaking study/training?
(tick one) Yes No
If yes, course/program name:
(tick one) Full time Part time Distance Other
Previous employment (most recent first)
Office use
Employer name/ check
establishment Dates from/to Position held Reason for leaving initial/date
Do you agree to have referees contacted in relation to this
application? (tick one) Yes No
(Reference checks will be conducted legally in an ethical manner and all information derived
will remain confidential.)
Please provide details of three people who can speak on your behalf regarding your work
history.
Office use
Position held/working relationship check
Name Contact No. (eg supervisor) initial/date
Please provide any other information that you identify as being pertinent to this application.
Declaration
I declare that, to the best of my knowledge, the information given is true and correct. I
understand that inaccurate, misleading or untrue statements or knowingly withheld
information may result in termination of employment with this organisation. I understand that
this application does not constitute an offer of employment. I understand that, in some
cases, police and credit checks will be required and I will be notified if this applies to this
application.
Signed: Date: