UPLOAD CV HERE
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Position Applied For
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Location of position
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PERSONAL DETAILS
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First Name
Last Name
Gender
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Ethnicity
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Australian
Australian Aboriginal
Australian South Sea Islander
Chinese
Cook Islander
European
Fijian
Hawaiian
I-Kiribati
Indian
Maori
Melanesian and Papuan
Micronesian
Nauruan
New Caledonian
New Zealander
Niuean
Ni-Vanuatu
Norfolk Islander
Papua New Guinean
Prefer Not To Specify
Pitcairn
Polynesian
Samoan
Singaporean
Solomon Islander
Tahitian
Tokelauan
Tongan
Torres Strait Islander
Other. Please specify below:
Are you known by any other name? If Yes, what other names are you known by?
First Name
Last Name
Address
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Region/State/Territory
Postal Address (if different)
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Home Phone
(###)
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Work Phone
(###)
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Mobile Phone
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(###)
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Email address
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Date of Birth
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Are you a New Zealand/ Australian Citizen?
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If yes, can you produce evidence if required?
If no, do you have the right of permanent residence or a work permit? (It will be necessary to produce your passport and associated documentation for verification)
If you hold a work permit, what is the expiry date?
What is your country of origin?
What is your passport number?
Visa Type Specification:
School/Polytechnic/University/Apprenticeship/Other (Years)
Qualifications (and year conferred)
SPECIFIC REASONS FOR APPLYING FOR THIS POSITION:
Organisation / Location
Position title
From / To (month/year)
Key Position Accountabilities (include any relevant job dimensions)
Key Achievement(s) in position
Reason for leaving (where applicable)
Notice period required
Organisation / Location
Position title
From / To (month/year)
Key Position Accountabilities (include any relevant job dimensions)
Key Achievement(s) in position
Reason for leaving (where applicable)
Please declare any current health or physical matters and/or impairments which may be aggravated or prevent your ability to carry out tasks in this position (e.g. back, hearing, eyesight or heart problems, or any physical injury):
Are you a smoker?
Do you have any allergies/intolerances that we should be aware of? (e.g. peanuts, other nuts, food allergies, aversion to heights, etc)
Have you had any previous injury or medical history in the last 10 years?
Have you had any previous back problems?
In your previous employment have you been exposed to:
Do you agree to undergo a full medical examination (including a test for class A, B or C drugs)?
Do you wear contact lenses?
Are you prepared to work shifts if required to do so?
Have you worked shifts before?
Are you prepared to work overtime if required?
Have you ever been convicted, diverted or convicted and discharged in relation to any criminal offences?
Are you awaiting the hearing of charges in a civil or criminal court of law?
Do you agree to police disclosure being sought?
Have you had a formal warning from a previous employer?
Have you ever been dismissed from previous employment?
Have you ever been banned from Foodstuffs, Progressive or Coles store?
Have you ever been made redundant from previous employment?
Do you own a smart phone for payroll – clocking in/out purposes?
Do you have a spouse, partner, relative or household member working here or elsewhere in the industry?
If Yes, who?
Are you prepared to handle all products, materials and equipment used in the industry?
Do you have a current New Zealand driver’s licence?(copy attached)
If yes, Number:
Licence type
Classes held:
Any demerit points
Has your licence ever been endorsed?
If yes, give brief details:
Do you have a current Australian driver's licence?
If yes, Number
Licence type
What transport arrangements have you to get to and from work?
If you intend to drive yourself to work, what is the registration, make and model of your vehicle?
Are you a member of any territorial force unit?
If so, have you completed the whole time training?
Do you consent to the Company retaining the information contained in your application for the purposes of considering your suitability for any other position that may arise in the future?
Referee Name / Relationship
At least 4 names and your relationship with them (i.e. managers, colleagues or staff)
Referee Contact Phone Numbers (day and after hours)
I consent to Prolife Foods Limited seeking verbal or written information on a confidential basis about me from the above referees, and I authorise these referees to release information to Prolife Foods Limited for the purposes of ascertaining my suitability for this position.
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I declare that, to the best of my knowledge, the details given in this application form are accurate and correct and I understand that if any false or deliberately misleading information is given, or any material fact suppressed, my application will not be accepted, or if I am employed, my employment will be terminated.
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