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Employment application form

Personal Details

Previous employment history:

  • (list last employer first):
  • (list last employer first):
  • (list last employer first):

Health/medical history:

Have you had or do you have any illnesses, injuries or disability (e.g. asthma, back injury, epilepsy) which may affect your:

Please provide details of any Worker’s Compensation Claims for illness or injury in the past 10 years.

Date and nature of claim Employer Claim Period

Special requirements:

School standard achieved:



  • (Tick whichever is applicable)

Emergency contact details:

  • In an emergency whom should we contact?


  • Further details will be required, such as bank information and a tax file number upon commencement of employment.