COPPER MINES
OF TASMANIA
Locked Bag 1, Penghana Road, Queenstown in Tasmania 7467
Telephone: (03) 6471 1666
Facsimile: (03) 6471 1916
A.C.N. 065 339 835
A.B.N. 36 065 339 835
GUIDELINES FOR APPLICANTS
APPLICATION FOR
EMPLOYMENT
To further support your application, it would be advantageous if you could supply
Photostat copies of the following documents, where applicable (originals should NOT be
sent, if at all possible)
Trade Papers and Indentures, Certificates, Diplomas, Plant Operator’s Tickets,
References, Driver’s Licence, Union Tickets
POSITION APPLIED FOR:……………………………………………………………………………………………….
TYPE OF EMPLOYMENT SOUGHT: Permanent / Part-time / Casual
PERSONAL DETAILS
TITLE: Mr / Mrs / Ms / Miss / Dr
SURNAME:…………………………………………………….
GIVEN NAMES: ............................................................................................................................................................
PREFERRED NAME: ...................................................................................................................................................
RESIDENTIAL ADDRESS: ...........................................................................................................................................
SUBURB/TOWN: ......................................................... STATE/POST CODE: .............................................................
TELEPHONE: (Home) ................................................. (Work) ....................................................................................
DATE OF BIRTH: ......................................................... MARITAL STATUS: ................................................................
GENDER: Male / Female
AUSTRALIAN RESIDENT: Yes / No – If No give details .........................................................................................
..................................................................................... ................................................................................................
DRIVERS LICENCE: Current: Yes / No
Status:……………
Class:…………… Licence No:………………
OTHER VEHICLE / OPERATOR LICENSES: Current: Yes / No
Details: .............................................................
EDUCATION / TRAINING
Year Completed
Name of Institution/School
Level Attained i.e. Degree, Diploma
SECONDARY
TRADE
TERTIARY
OTHER/FURTHER QUALIFICATIONS, TRAINING, COURSES:………………………………………………………..
…………………………………………………………………………………………………………………………………..
TRADE DETAILS
APPRENTICESHIP TRADE: ....................................... SERVED: When / Where: .......................................................
TRADE PERMIT (S) LICENSES
NUMBER
STATE OF ISSUE
EXPIRY DATE
(dd/mm/yy)
RENEWED
(Months)
CURRENT UNION MEMBERSHIP: ............................. ………………. TICKET NUMBER: ........................................
OTHER TRADE EXPERIENCE: ...................................................................................................................................
NB: Copper Mines of Tasmania is a non-compulsory union organization. You may join a union if you wish, but it is not
compulsory.
EMPLOYMENT HISTORY
CURRENT EMPLOYER (Name and Address): ............................................................................................................
..................................................................................... DATE COMMENCED: ............................................................
POSITION HELD: ........................................................ PERSON TO WHOM YOU REPORT: ....................................
PERIOD OF NOTICE REQ’D: ..................................... MAY WE CONTACT YOUR CURRENT EMPLOYER: Yes / No
PRESENT SALARY / WAGE AND BENEFITS: ........... ................................................................................................
BRIEF SUMMARY OF DUTIES: .................................. ................................................................................................
..................................................................................... ................................................................................................
..................................................................................... ................................................................................................
..................................................................................... ................................................................................................
PREVIOUS EMPLOYMENT (List most recent first)
Employer/Address
From - To
(mm/yy)
Position held/Person to
whom you reported
Reason for leaving
HEALTH
In order for us to assess how best to accommodate you in any particular work environment, please complete the
following:
Has your health ever hindered you being accepted by any employer or in performing any particular tasks / jobs? Yes /
No
Have you ever had or do you now have any of the following. Please give details if still receiving treatment:
1)
Heart or blood pressure problems - Yes / No....... ................................................................................................
2)
An ear disorder or deafness - Yes / No ................ ................................................................................................
3)
Fainting spells, blackouts, dizziness, convulsions, fits of any kind, epilepsy – Yes / No ......................................
..................................................................................... ................................................................................................
4)
Nervous breakdown or disorder - Yes / No .......... ................................................................................................
5)
Hernia (rupture) – Yes /No .................................... ................................................................................................
6)
Back or spinal problems - Yes / No ...................... ................................................................................................
7)
Skin trouble (eczema, tinea, dermatitis) – Yes / No ...............................................................................................
8)
An allergy of any kind - Yes / No .......................... ................................................................................................
9)
Tuberculosis - Yes / No ........................................ ................................................................................................
10) Lung disease or disorders including asthma - Yes / No ........................................................................................
11) Have you ever had any surgical operations - Yes / No (If yes, please give details) .............................................
..................................................................................... ................................................................................................
12) Have you have ever had any serious injury or illness? - Yes / No (If yes, please give details) ...........................
..................................................................................... ................................................................................................
13) If you are unable to work under any of the following conditions, please circle:
a)
c)
e)
g)
hot conditions
climbing
in confined areas
wet/muddy conditions
b) at heights
d) underground
f) in dark areas
Other .......................................................................................
d)
Name and address of your doctor: .................. ................................................................................................
..................................................................................... Telephone: .............................................................................
e)
Name and address of Next of Kin: ................... ................................................................................................
Relationship: ........................................................... Telephone: ..............................................................................
f)
Are you currently receiving any medical attention from a doctor, hospital or anyone else? Yes / No
(If yes give details) .......................................... ................................................................................................
g)
Have you ever received Workers’ Compensation? Yes / No
When
(dd/mm/yy)
Employer
Nature of injury
Days lost
REFEREES
NAME
COMPANY
POSITION
TELEPHONE NUMBER
Business:………………………… ……………………………
………………………..
………………………..
Business:…………………………
………………………….
.………………………..
………………………..
Personal:…………………………
……………………………
. ……………………….
..………………………..
OTHER
Hobbies/sports played:……………………………………………………………………………………………………….….
Other useful information:…………………………………………………………………………………………………………
GENERAL INSTRUCTIONS
1) Acceptance of this application by the Company does not imply eventual employment.
2) This form must be completed in the applicant’s own handwriting.
DECLARATION
1)
I declare that, to the best of my knowledge, the information supplied by me in this application is correct and that the
Company has the right to verify any of the information I have given. I further understand that any false statement or
deliberate omission will prevent my employment or will be sufficient reason for dismissal should I commence
employment with this Company.
2)
I agree to my previous employers (other than my present employer), being requested to furnish a confidential report
on my service and to any of the nominated referees being asked for a reference.
3)
I give permission for the Company to obtain details of any Worker’s compensation claims that I have made in
previous employment.
4)
At the discretion of the Company, I agree to undertake drugs and alcohol testing prior to; or at any time during my
employment.
5)
I agree to attend a medical examination before employment or at any time during employment to be con-ducted by
a medical practitioner nominated by the Company.
6)
I also accept that all employment is subject to satisfactory medical examination results and that the Company’s
decision on this matter is final.
7)
I will observe the Company’s safety rules and wear safety equipment and/or clothing as required by the Company. I
agree to work shift as and when required by the Company.
8)
I accept that employment would involve an initial probationary period.
APPLICANT’S SIGNATURE:……………………………………………………
DATE:……/ ………/ ……