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| Title: | Mr Mrs Miss Ms | ||
| First Name: | Middle Name(s): | ||
| Surname: | Preferred Name: | ||
| Phone Number: | Home: | and/or Mobile: |
| Date of Birth: | DD/MM/YYYY | / / |
| Are you a backpacker? | Yes No |
| Physical Address | |||
| Physical Address: | Suburb: | ||
| Postcode: | State: |
| Postal Address - Tick if same as Physical Address | |||
| Section 2 - Contact / Emergency Persons |
| You must provide 2 contacts. One of these contacts must be someone, not at your address, with whom a message can be left. |
| Contact #1 | Contact #2 |
| Name: | Name: | ||
| Phone: | Phone: | ||
| Relation: | Relation: |
| Section 3 - Suitable Positions
|
| I would like to apply for the following position/s. |
| Grading Only | Paddock Only | Forklift Only | Field Only | ||||
| Stacking Only | Harvester Only | Supervisor Only | Office Only |
| Section 4 - Qualifications / Licences
|
| Current Fork licence: | Yes No |
| Current First Aid certificate: | Yes No |
| Give details of any other licences, permits or trade certificates you have (100 Character limit): |
| Section 5 - Employment History
|
| This information will help to ensure your skills are utilised effectively. Please provide as much detail as possible. |
| Job Network Member |
| Have you been employed perviously by Field Fresh Tasmania? | Yes No |
| If yes, please provide details (including dates): |
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| Have you had any experience in the following areas? |
| Farm work including the harvesting of fruit or vegetables | Yes No | Manual labour | Yes No | Grading / Packing of produce | Yes No | Computer usage | Yes No |
| If you have answered Yes to any of the above questions, please provide details below (150 Character limit): |
| Please provide 2 names and details for referee checks, 1 must be a work referee: |
| Referee #1 | Referee #2 |
| Period of employment (dates) | Period of employment (dates) | ||
| Name of referee | Name of referee | ||
| Brief description of your duties | Brief description of your duties | ||
| Telephone | Telephone | ||
| Position held | Position held |
| Section 6 - Availability |
| What date are you available to start work? | DD/MM/YYYY / / |
| Do you have reliable transport, means of getting to work? | Yes No | Are you available seven days a week? | Yes No |
| There are up to 3 shifts with different starting and finishing times. We will make every effort to place you on the shift you prefer, but cannot guarantee it. |
List your preferred shift as 1 and the others as 2 and 3. Please tick any if available for any shift, but still number your preferences. |
| Any | Day | Afternoon | Night |
| Section 7 - Health Particulars |
| There are various roles within the organisation that require particular physical attributes. You may be required to work in a dusty and/or noisy environment, perform heavy lifting, perform repeditive manual work or operate machinery. To ensure that we can meet our duty of care and place you in a position that you are suited to please select your awnser yes or no to every question, and provide details if necessary. |
| Is there any reason why you would be unable to complete any of these tasks? | Yes No |
| If yes, what alternative arrangements do you require, enabling you to complete these tasks? (100 Character Limit) |
| Have you previously had a Worker's Compensation Claim? | Yes No |
| If yes, please provide dates and details: (100 Character Limit) | |
| Employees will be required to participate in a Health assessment conduct by an appropriate Health Professional, in relation to your capacity to work at Field Fresh Tasmania. Please note - It is important that as this time, you inform the Health Professional if you are taking any prescribed medication. |
| Would you be prepared to participate in a Health Assessment and Monitoring? | Yes No |
| Field Fresh Tasmania has a strict Drug and Alcohol Policy. Due to the working environment we have a zero tolerance on drugs or alcohol impairment. |
| Are you willing to undertake a Drug and/or Alcohol Test? | Yes No |
| Section 8 - Applicant Declaration |
| The terms and conditions of employment with Field Fresh Tasmania are in accordance with the Field Fresh Tasmania Employee Collective Agreement 2007 and the Field Fresh Tasmania Employee Handbook. Any offer of employment made by Field Fresh Tasmania is based upon the accuracy of statements contained in this Employment Application Form. | I declare all statements made in this Employment Application Form to be, to the best of my knowledge and belief an accurate statement of facts. | I further understand that any false statement may be sufficient reason for instant dismissal and the termination of my employment. | I Agree |