Application For Employment
POSITION APPLIED FOR: .................................................................
APPLICANT DETAILS
SURNAME:
AGE:
GIVEN NAME/S:
DOB:
CURRENT ADDRESS:
P/CODE:
PHONE – Home :
PHONE – Mobile:
Email:
What language do you use/speak at home?
Are you willing to do shift work?
Yes (
)
No (
)
Are you willing to do overtime?
Yes (
)
No (
)
Are you willing to work away?
Yes (
)
No (
)
Do you have a current Drivers Licence?
Yes (
)
No (
)
If YES, which Class?
Which State?
Drivers Licence No:
EDUCATION
From:
To:
Institution:
Qualifications Awarded:
REFEREES
Please provide two (2) work related references. These referees should have been your immediate
supervisor in your past or existing role.
Name of Referee:
Name of Referee:
Position Referee Held:
Position Referee Held:
Phone No:
Phone No:
Name of Organisation:
Name of Organisation:
AMS – Application For Employment – Form 002
Rev 7 – 09/05/2015
Application For Employment
EMPLOYMENT HISTORY
Employer:
Period of Employment:
Position Held:
Responsibilities:
Employer:
Period of Employment:
Position Held:
Responsibilities:
HEALTH DECLARATION
You will be required to undertake a pre-employment medical before an offer is made to you. Medical
advice received will help us assess your ability to perform the inherent requirements of the job for which
you are applying. To assist in this matter please answer the following questions carefully and provide any
other information on your past and present health which may be relevant.
In line with company policy RIG Installations will ensure that these answers will not prejudice an
employment opportunity.
1.
Have you ever had, or do you currently suffer from, any of the following? (indicate with a
cross (X) where applicable):
Heart attack / stroke
Yes
[
]
No
[
]
Injuries to the limbs (hands, feet etc)
Yes
[
]
No
[
]
Broken bones
Yes
[
]
No
[
]
Injury to the eyes
Yes
[
]
No
[
]
2.
Do you have any personal disabilities?
Do you suffer from:
Soreness or injury to your back
Yes
Any hearing deficiency
Yes
Vertigo (fear of heights)
Yes
Hypertension (blood pressure problems)
Yes
Diabetes
Yes
Asthma or any other respiratory problems
Yes
[
[
[
[
[
[
]
]
]
]
]
]
No
No
No
No
No
No
[
[
[
[
[
[
]
]
]
]
]
]
Other (please detail):
3.
Have you ever been on Workers Compensation?
If Yes, please provide details.
Yes [
]
No [
]
4.
Are you being treated for a Workers Compensation Injury that has not been finalised?
Yes [
]
No [
]
5.
Do you suffer from a hearing Impairment?
If so, have you notified your previous employer?
Yes [
Yes [
]
]
No [
No [
]
]
Any offer of employment is strictly subject to a true and accurate answer being given in response
to all of the above questions.
I declare that all the answers I have given in this declaration are true and correct and I understand
that I may be employed by rig installations on the basis of such answers.
Signature: ______________________________ Date: __________________
AMS – Application For Employment – Form 002
Rev 7 – 09/05/2015
Application For Employment
INDUCTION AND TRAINING
Please enter your Induction & Training details below.
Please tick in the box that relates to your training and enter Expiry date and Valid number in boxes given.
For all induction details the original certificate must be presented so a copy can be made for our files.
If you have Trade papers for your position (e.g. Boilermaker, Fitter) these originals must also be supplied.
Load Shifting / Platforms
WP – Elevated Work Platform
HM – Material Hoist
LF – Forklift Truck
LO – Order Picking Forklift Truck
Front End Loader
Front End Loader / Backhoe
Front End Loader Skid Steer Type
Excavator
Date Issued
Training
WHS Construction White Card
First Aid Certificate
Confined Space Enter and Work
Confined Space Advanced
Working Safely at Heights
Electrical Test and Tag
MDG 25 Hot Works
Other
Scaffolding, Dogging, Rigging
SB – Basic Scaffolding
Date Issued
Current Site Inductions
OneSteel Issue Date
Mayfield
Mayfield Main
Gate
Rod Mill
Contistretch
ATM
SI – Intermediate Scaffolding
SA – Advanced Scaffolding
DG – Dogging
RB – Basic Rigging
RI – Intermediate Rigging
RA – Advanced Rigging
Crane & Hoist
CT – Tower Crane
Date Issued
Expiry Date
Moly Cop Waratah
Level 2
Departments
Issue Date
Expiry Date
Tomago
Aluminium
Main Gate
LMO
RAO
Pitch
CPO
Maintenance
Ops Services
Issue Date
Expiry Date
MINE Sites
Bulga Coal
Mt Owen
Other
Issue Date
Expiry Date
PWCS
Kooragang
Issue Date
Expiry Date
NCIG
Operations
Issue Date
Expiry Date
Other
Issue Date
Expiry Date
Date Issued
CP – Portal Boom Crane
CV – Vehicle Loading Crane
CD – Derrick Cranes
CS – Self Erecting Tower Crane
CB – Bridge & Gantry Crane
CN – Non Slew Mobile Crane
C1 –Slew Crane (up to 100T)
C2 – Slew Crane ( up to 20T)
C6 – Slew Crane (up to 60T)
CO – Slew Crane (over 100T)
Welding Tickets
Cert 1 / 1E – MMAW
Cert 2 – MMAW
Cert 3 / 3E – MMAW
Cert 4 – MMAW
Cert 5 – GTAW/MMAW
Cert 7 – GTAW
Cert 8F – FCAW
Cert 8G – GMAW
Cert 9 – Automatic Welding
Cert 10 – Welding Supervisor
AMS – Application For Employment – Form 002
Rev 7 – 09/05/2015
Application For Employment
DECLARATION – PLEASE READ CAREFULLY
I declare that all of the answers I have given in this application are true and correct and I understand that I
may be employed by RIG Installations on the basis of such answers.
I also declare that I have written in detail in the Health Declaration of this application, all the known
occupational Injuries and Illnesses that I still suffer from, or, have suffered from in the past. This includes
any injury or illness that has resulted in a Worker’s Compensation claim.
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.
If accepted for employment, I agree to follow the safe working policies, procedures and instructions of the
Company, and I agree to use / wear personal protective equipment issued (and/or requested) as required.
If accepted for employment, I agree to abide by all Policies, Procedures and Regulations governing the
industry under the Work Health and Safety Act 2011.
If accepted for employment, I agree to notify the Company within two (2) working days of any changes to
any of the details submitted on this application.
Signature: ______________________________ Date: __________________
EMPLOYMENT ENGAGEMENT FORM
1.
Employment Start Date:
2.
Emergency Contact Details:
____ / ____ /____
NAME:
NAME:
PHONE:
PHONE:
RELATIONSHIP:
RELATIONSHIP:
3.
If you are a financial member of a registered trade union AND would like your union fees
deducted weekly from your pay, please provide details
Union Name:
4.
Union No:
Are you currently registered with a superannuation fund? YES (
If YES, which fund?
5.
)
NO (
Membership No:
Banking Details.
Bank Institution Name:
Account Holders Name:
Branch:
BSB Number:
___ ___ ___ - ___ ___ ___
AMS – Application For Employment – Form 002
Account Number:
Rev 7 – 09/05/2015
)