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One Stop Garbage Shop

Job Application Form

CONFIDENTIAL Q&A: Revised Staff Details/Job Application

ATTENTION APPLICANTS – Existing Employees / New Employees

This questionnaire is designed to give a preliminary assessment of your offer to the company and where applicable make up a minor percentage of the selection criteria for the position within the company. It is not a sole basis for your selection and remains confidential. Your confidential information is held in trust along with your other relevant personal information and kept within relevant confidential company personnel files.

Please answer honestly. Although we prefer all questions completed, answers must be provided for several Mandatory fields, the numbers of which are marked with a *. If you do not wish to answer question(s), please indicate by writing ‘I Decline to answer’ in the space provided for that question. A reason for why you do not wish to answer can be given if you like. All questions relate to a specific area of employment / eligibility. Attach extra sheets if necessary.

1.	*Please name the position you are applying for; or your existing title with this company now?

2.	*Last Name

3.	*Given Names

4.	Sex

5.	*Date of Birth
	(dd/mm/yyyy)
6.	*Country of Citizenship

7.	*Current Place of Residence

	*Postcode

	*State

8.	*Postal Address (if different from above)

	*Postcode

	*State

9.	Forms of Contact
	Phone (AH) Mobile
	Email
10.	Other Contacts
	Next of Kin Relationship Phone (AH)
11.	*Current Employment Status

12.	Are you physically fit ?

13.	How would you best describe your health ?

14.	Are you a smoker ?

15.	*Do you have your own reliable transport ?
	If yes, give details
16.	Are you reliable ?

17.	*Have you ever had a Work Cover compensation Claim for injury(s) that occured at work ? If yes give details.

18.	*Please document any existing or pre-existing Physical injuries or Medical Conditions that may affect your performance at work ? Please note: You are obliged to disclose all injuries/conditions/mental illnesses/or other that may affect your ability in any way whatsoever to perform the work without injury. Workers Compensation may be denied if you fail to disclose a condition which later is aggravated by your employment or that may affect your ability to carry out duties safely, and without placing yourself or others at risk. If yes give details.

19.	*What is your First Spoken Language ?

20.	*List all other language(s) spoken if any ?

21.	*Are you available to start the position you are applying for immediately (within 5 days) ?

22.	If you answered ‘No’ to Q.21 please give details of your notice period ?

23.	Do you see yourself as someone who can accept a challenge and carry it through to its completion ? Give details.

24.	Are you a routine orientated person? If yes, please give details.

25.	If you have established or are part of a routine scenario, how do you feel and what do you do if something unexpected occurs that throws the routine out of balance ?

26.	Why should this company choose you for this position and not someone else with the same qualifications; (existing company staff) or, why should the company consider you for greater responsibilities or special projects, payrises ?

27.	*Please list any other useful skills, that you possess.

28.	*Have you previously worked under an expectation where ‘full time’ staff are expected to work un-paid hours (where necessary) to complete a task? This includes such un-paid areas as arriving at work early to make necessary preparations to allow smoother work days, and or staying back after the day’s end to ensure all items/issues are correctly signed off for that day/week? Give details ?

29.	*Have you ever been in trouble with the Police ?

	If you answered ‘Yes’ to the above, you may choose to give details or only select the Yes/No if you wish. (Answers must be honest, however you may write ‘I decline to answer’ in the space provided if you wish)

30.	*Have you ever been convicted of a drink-driving offence ?

	If you answered ‘Yes’ to the above, please give details.

31.	If the company has specified that you are required to drive Company Vehicle(s) as a part of your job description, please attach an original VIC Roads ‘Demerit Points’ Report which can be obtained by paying a $6.00 fee to VIC roads over the telephone, or by visiting your nearest VIC Roads Offices and purchasing over the counter.
32.	If you answered Yes to Q.29, do you give this company permission to request a copy of your police record

33.	Have you received a speeding infringement in the last two (2) years? Yes, give details.

	Submit your Resume Before submitting this form, please attach and send your resume to OSGS here
	Declaration To my knowledge the above questions relating to myself have been answered truthfully and correctly.
	*Full Name
	*Date of submission (dd/mm/yyyy)