Name *Email Address *TelephoneCell Phone *Street Address *EducationName of the College or Institution *0 / 300From *To *Subjects Taken or Qualifications *Name of the College or Institution *From *To *Subjects Taken or Qualifications *Employment HistoryName of Employer *Address & Contact Number *From *To *Details *Name of Employer *Address & Contact Number *From *To *Details *Name of Employer *Address & Contact Number *From *To *Details *Name of Employer *Address & Contact Number *From *To *Details *RefereesReference 1 *Contact Number *Reference 2 *Contact Number *Reference 3 *Contact Number *If applying for Plumbing, Roofing, Gasfitting or Drainage PositionsDo you have any of the following qualifications: (tick that apply)Do you have any of the following qualifications: (tick that apply) *Registered PlumberRegistered GasfitterRegistered Drain layerCraftsman PlumberCraftsman GasfitterTrades person Electrical work certNot ApplicableWhat is your License Number? *0 / 200Have you passed any papers? *0 / 200Do you have any other qualifications? *0 / 500GeneralDo you object to enquiries of your present employer? *YesNoDo you object to enquiries of your past employer? *YesNoAre you prepared to work extra hours or overtime? *YesNoAre you prepared to handle all product normally used in the industry? *YesNoDo you have a current and clear drivers license? *YesNoHave you been convicted of a Criminal Offence? *YesNoIf yes, give details.Details:0 / 500Do you have any commitments at this time which would prevent you from attending your place of employment in the future? *YesNoIf yes, give detailsGive Details0 / 500Do you have any part time of secondary employment? (Voluntary or Paid) *YesNoCan you bring any work into the business? *YesNoIf so what?Work details0 / 500Do you know anyone in the industry? *YesNoIf yes, give nameName0 / 100Are you paying outstanding court fines? *YesNoIf so then for what?Fine details *0 / 500MedicalHave you had any previous illness or injuries? *YesNoIf yes, give dates and detailsIllness or injuries details *0 / 500Have you lodged an ACC Claim in the last six years? *YesNoIf yes give detailsACC Claim Details0 / 500Have you suffered from: *Black outs / fitsAsthmaHerniaHigh Blood PressureHeart ConditionDiabetesDo you wear glasses or contact lensesAlcoholismMigrainesAllergiesHeadachesRheumatism/ArthritisR.S.I.Ear ache / DeafnessBack injury / StrainAre you on medicationDrug AbuseCovid-19None of the above(Tick where appropriate)Have you been vaccinated for Covid-19 *YesNoIf yes, when were you vaccinatedUpload Vaccine PassChoose FileNo file chosenDelete uploaded fileWhat is the reason for not getting vaccinated? *Do you have an exemption for Covid-19 vaccinations? *YesNoUpload Vaccine ExemptionChoose FileNo file chosenDelete uploaded fileIs that the reason why you cannot work on the site? *Can you get vaccinated and continue with the application? *YesNoCovid-19 vaccinated details (Vaccination dates, etc.)0 / 500If on medication, give details0 / 500Do you smoke? *YesNoHave you had (or have) any drug/alcohol dependencies? *YesNoIf you have suffered or currently have back injury strain or pain, give details:Did this back injury or pain happen inIn your current jobWork accidentMedical reasonIn another jobInjury outside workWhat treatment have you had for this back pain or injury or strain0 / 500Have you lodged an ACC Claim for a back injury?YesNoIs there anything that could prevent you from carrying out your work with us?0 / 500Are you prepared to up skill in your own time? (Up to 3 hours a month)YesNoUpload CVChoose FileNo file chosenDelete uploaded fileUpload Driver's LicenseChoose FileNo file chosenDelete uploaded fileUpload QualificationsDrag and Drop (or) Choose FilesConsent *I declare this application is a true and correct record and understand that if any of the information is false or material fact suppressed, I may not be accepted or if I am employed, I may be dismissed without warning or notice.Date *Send MessagePlease do not fill in this field.
