EMPLOYMENT APPLICATION

Applicant to complete using BLOCK letters

Position applied for: Customer Service Officer
Full time: Please tick ü / Part-time: Please tick / Casual: Please tick / Other Please tick and specify
……………………………………
Date available to commence:
Title: Dr / Mr / Mrs / Miss / Ms
Family Name: / First Name:
Other names by which you have been known in the last 5 years:
Address:
Postcode:
Phone (home): / Phone (mobile): / Phone (work):
Email:
Driver’s Licence Number: State of Issue:
Proof of Eligibility to Work in Australia
The following are acceptable documents. Originals will be viewed and a photocopy taken after successful interview. Please tick the document which will be produced at interview. A Department of Immigration and Citizenship (DIAC) approved check may be required or the presentation of a Visa. By signing this application you agree to this check being undertaken.
Birth Certificate: / Citizenship Certificate: / Australian Passport: / Visa
Do you speak any other languages? Please tick Yes: / No:
If yes, please specify ………………………………………………………………………………………………………………………………………………….
Do you have any criminal convictions? Please tick Yes: / No:
A Federal Police Check is compulsory for all preferred applicants. These checks are paid for by Adssi.
Do you have any hobbies, qualifications, skills or other interests that may be of interest to Adssi? Eg volunteer work
Do you have any known injuries, disabilities or health problems likely to affect your ability to perform the position applied for or that may endanger the health of you or another person? Please tick Yes: / No: If yes, please provide details:

Applicant’s Statement

The above information is correct to the best of my knowledge and belief. Any statement on this form found to be deliberately misleading may lead to non-progression of my application, or, if I have been employed, disciplinary action and/or dismissal.

I am aware that an offer of employment is made subject to my fulfilling the inherent requirements of the position demonstrated by satisfactory pre-employment checks which could include a range of medical tests, an occupational therapy assessment and/or a psychometric test, and will include a police check, bankruptcy check, reference checks, confirmation of relevant qualifications and confirmation of my right to live and work in Australia.

Name of Applicant: ______Date: _____/_____/_____