EMPLOYEE CENSUS & SET-UP FORM
PLEASE COMPLETE AND SIGN PAGES 4, 5 & 6
Personal Details
☐ Mr.
☐ Mrs.
☐ Ms.
☐ Miss
First Names
Last Name
Preferred Name
Street Address
Suburb
Post Code
Home Phone
Email Address
Mobile
Date of Birth
Drivers Licence
Drivers Licence Number
Expiry Date
Yes
No
☐
☐
Emergency Contact details
Full Name:
Relationship:
Address:
Home Number
Mobile
Testing & Qualifications – (OFFICE USE ONLY)
Drug & Alcohol Test
☐
Pre-Placement Medical
☐
Musculoskeletal Assessment
☐
Rio Tinto Inducted (HSE)
☐
BHP Inducted
☐
GSDU Clearance
☐
Speakeasy Australia Pty Ltd T/AS PLUS 8 Group (ABN 65 127 864 297) – Revised 1st December 2013
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Employment History – please list the most recent position first
Start and End Dates
Position Held
Organisation Name
Referee Name and
Number
Capacity to work declaration – please include separate sheet if required
Due to occupational health and safety requirements, do you have any
condition or injury that may pose a significant risk to others?
If yes, please state details:
Do you have any pre-existing medical conditions or injuries that will
any way, hinder your ability to perform the tasks of the position for
which you applied?
If yes, please state details:
Have you ever claimed workers compensation?
If yes, please state details:
Are you required to take any medication that may affect or hinder your
work performance?
If yes, please state details:
Would you be willing to undertake and alcohol and other drug test if
required?
Would you be willing to undertake a medical examination if required?
Do you suffer from any back, neck, shoulder or knee complaints that
may affect your ability to perform the duties required of the position
for which you have applied for?
If yes, please state details:
Yes
☐
No
☐
Yes
☐
No
☐
Yes
☐
No
☐
Yes
☐
No
☐
Yes
☐
No
☐
Yes
☐
No
☐
Yes
☐
No
☐
Yes
☐
No
☐
Yes
☐
No
☐
Convictions
Do you have any convictions for any offences from any court, or are
you currently the subject of any charge pending before any court? You
do not need to give details of any conviction which you have had
declared spent, quashed or pardoned.
If yes, please provide details:
Are you able to provide a police clearance
Speakeasy Australia Pty Ltd T/AS PLUS 8 Group (ABN 65 127 864 297) – Revised 1st December 2013
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Bank & Payroll Details
Account Name
Bank Name
BSB
Account Number
Tax File Number
Tax Dec Form
Click here to enter text.
#7
#8
#9
Y☐N☐ Y☐N☐ Y☐N☐
#10
Y☐N☐
#11
Y☐N☐
Nationality
Passport Number
Visa Number
(if not Australian)
Visa Type (e.g. 417)
Visa Expiry Date
The remuneration paid to you includes all payments and benefits that the Employer is legally obliged to
provide to you. The effective hourly rate of pay for hours worked is specifically off-set against, applied to
and absorbs any existing or newly-introduced payments or benefits to which you are or may become legally
entitled, including but not limited to:
i.
ii.
iii.
iv.
v.
all hours worked by the you including all hours worked in excess of the ordinary hours;
your entitlement to overtime rates and penalty rates (if applicable);
your entitlement to allowances;
your entitlement to annual leave loading (if you are employed on a permanent basis); and
the Employee’s entitlement to any payment, benefit, or other form of loading under any
applicable award, Agreement, Contract or legislation.
Speakeasy Australia Pty Ltd T/AS PLUS 8 Group (ABN 65 127 864 297) – Revised 1st December 2013
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Key Employment Census Terms
1. I understand that completion of these forms does not constitute employment with the PLUS
8 Group.
2. I certify that the information supplied in my resume and within this Employee Census & SetUp Form is true and correct.
3. I understand that false, misleading or nondisclosure of information may result in future
disciplinary action including termination of employment.
4. In the event of a work related illness or injury I (i) will proactively co-operate and
participate in rehabilitation; and (ii) give permission to the treating medical practitioner to
discuss my medical information relevant to my injury or illness with the Rehabilitation
Coordinator for the management of my injury or illness and/or development of a
rehabilitation program.
5. I understand that I will pay for medical tests, drug and alcohol tests and/or inductions if
required by PLUS 8’s client’s prior to my employment with PLUS 8. If I am unable to pay
for these directly PLUS 8 may offer to pay for these costs directly in the form of a loan. I
agree to repay the full amount within 10 days or authorize PLUS 8 to recoup the full
amount from my first pay. See ‘Form DAI’ and/or ‘Form URF’.
6. I understand that my employment is governed by the Tri-Nation Holdings Employee
Collective Bargaining Agreement and the superannuation fund is AMP Super leader.
7. I have read the PLUS 8 (i) Code of Conduct (attached), (ii) Employee Handbook; and (iii)
OHS Manual and fully understand my obligations and responsibilities whilst employed by
PLUS 8 recruitment.
I understand that PLUS 8 Recruitment will not use or disclose personal information (other than for
the primary purpose for which it was collected and except when required by law) for a purpose not
related to its business activities and functions without the documented consent of the individual.
In signing this form, I agree and give consent to PLUS 8 Recruitment to contact previous employers
and referees for reference checking and disclose my personal information to third parties such as
PLUS 8 clients and potential clients in PLUS 8’s attempt to find me suitable employment.
___________________________
Signature
____________________________
Date
Speakeasy Australia Pty Ltd T/AS PLUS 8 Group (ABN 65 127 864 297) – Revised 1st December 2013
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PLUS 8 Code of Conduct
Whilst employed with PLUS 8 it is necessary for you to familiarise yourself with our Code of
Conduct and abide by its requirements at all times no matter where you are on assignment.
You agree to:
Behave honestly and with integrity in the course of your employment with PLUS 8
Act with care and due diligence in the course of your duties towards yourself and colleagues
Comply with any lawful and reasonable direction given by a PLUS 8 manager or a Client who has
the authority to provide such direction
Behave and conduct yourself in a way that upholds the values, integrity and good reputation of
PLUS 8
Report any accidents or hazards to the relevant safety representative on site as soon as possible
Conduct yourself in a professional and reasonable manner at all times whilst at work and socially
Adhere to the Client’s Code of Conduct regarding dress standards and requirements for
travelling to and from site any rules and regulations regarding residing and working on the
Client’s premises
Conduct yourself in an orderly and contained manner when frequenting wet mess facilities,
being mindful and responsible regarding the level of any alcohol consumed and at all times
ensuring the safety of yourself and your colleagues .
Keep any PLUS 8 and Client information confidential at all times. Such information is provided
to you in order to ensure you can perform your role and must not be used for any other
purpose.
Disciplinary action may result should any employee fail to follow and adhere to the above Code of
Conduct. If such breach of the Code of Conduct is found to be of a serious nature then the
employee’s assignment may be terminated with immediate effect.
___________________________
Signature
____________________________
Date
Speakeasy Australia Pty Ltd T/AS PLUS 8 Group (ABN 65 127 864 297) – Revised 1st December 2013
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Uniform Requirements
Depending on the PLUS 8 client site, staff may be required to purchase some of the following items
before commencing employment.
Please speak with your recruitment consultant who will advise you on which items are necessary.
Product
Code
TTHV
Number
Required
Item
Colour
Two tone high-visual long sleeve shirts
KLSS
Khaki long sleeved shirt
LWDP
Light weight pre-shrink drill pants
SCB
Steel cap boots with laces
BSH
Black shirt
BDRS
Blue dining room shirt
HRU
Hotel required uniform
HKU
Housekeeping uniform depending on establishment
CP1
Chef pants
LSCJ
Long sleeve chef jacket
CH2
Chef hat
CA3
Chef apron
All staff working in remote areas must have steel cap boots with laces (no slip-on boots)
___________________________
Signature
____________________________
Date
Speakeasy Australia Pty Ltd T/AS PLUS 8 Group (ABN 65 127 864 297) – Revised 1st December 2013
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