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New Applicants:

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Existing Applicants:

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1. General Information

Position Applied For *

Clerical
Farm Hand
Mechanic
Truck Driver
Other

Other – Please Specify *

Name *

First

Last

Date Of Birth *

Address *

Address Line 1

City

State / Province / Region

Postal Code

Do you live outside 100km of Goulburn? *

How do you intend to attend work if engaged? *

Relocate
Commute
Other

Please provide details:

Mobile Phone *

Telephone

Email *

Licence Class *

Car (C)
Light Rigid (LR)
Medium Rigid (MR)
Heavy Rigid (HR)
Heavy Combination (HC)
Multi Combination (MC)
Rider
Learners (LRN)
No Licence

Drivers Licence Number *

Licence Expiry Date *

Have You Worked For Divall's or the Divall Group Previously? *

When did you leave? *

What was your reason for leaving? *

2. Skill Information

Do you hold a valid and current operators licence or are you able to demonstrate competency? *

Yes
No
Not Applicable

Please provide a detailed list of the licences held: *

Who have these licences been issued by? *

Registered Training Organisation (RTO)
WorkCover
Workplace Assessor

Within the last five (5) years, have you had any licence to operate any motor vehicle suspended or revoked by any authority for any reason? *

Please attach a page and state the date(s) and reason(s) for the suspension(s) or revocation(s).

Drag & Drop Files, Choose Files to Upload

Travel to projects as well as routine overtime and Saturday/Sunday work are common. You must be willing to travel when and where assigned and be available to work hours as determined by Divall’s. The company provides travel expenses and accommodation (if required) when employees are required to travel specific distances and stay away from home.

Are you willing to travel? *

Can you reliably get to your assigned worksite? *

Will you be reasonably available for overtime and weekend work when required? *

What is the earliest date you are available to start working? *

3. Health

Please provide any medical history or physical condition whuch may effect the position you have applied for:

Are you taking prescription medication on a routine basis?

Please list these medications:

Do you have a previous Workers Compensation claim(s)? *

Please provide details on the basis and status of these claims: *

Do you suffer from a sleep disorder?

Company Medicals

You understand, and agree that prior to engagement with the Company, you will be required to undergo and pass a Company Medical performed by our Company Doctor. The medical will include a hearing test, breathing test and urine, and/or saliva based drug test. The cost of the medical will be at the applicant’s expense (currently $65.00 subject to change) and will be reimbursed after three months sucessful employment.

Company Medical Understand *

I Understand
I Do Not Agree

4. Work History

Please provide your work history begining with your most recent employment:
The Company would like three references where possible.

Previous Employer 1 / Current Employer

Name Of Previous / Current Employer *

Phone Of Previous / Current Employer

Position Held

Brief description of the works performed:

Address Of Previous Employer

Address Line 1

City

State / Province / Region

Postal Code

Name Of Supervisor

Phone Number Of Supervisor

Commencement Date

Are you still employed here?

Completion Date

Reason For Leaving:

Do you have a second employer to list? *

Previous Employer 2

Name Of Previous / Current Employer *

Phone Of Previous / Current Employer

Position Held

Brief description of the works performed:

Address Of Previous Employer

Address Line 1

City

State / Province / Region

Postal Code

Name Of Supervisor

Phone Number Of Supervisor

Commencement Date

Are you still employed here?

Completion Date

Reason For Leaving:

Do you have a third employer to list? *

Previous Employer 3

Name Of Previous / Current Employer *

Phone Of Previous / Current Employer

Position Held

Brief description of the works performed:

Address Of Previous Employer

Address Line 1

City

State / Province / Region

Postal Code

Name Of Supervisor

Phone Number Of Supervisor

Commencement Date

Are you still employed here?

Completion Date

Reason For Leaving:

5. Background

Have you ever pleaded guilty to or been convicted of a criminal offence? *

Please provide a detailed explaination including the dates and circumstances surrounding this answer. *

Have you ever been suspended by any previous employer? *