Every Day Mine Services

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Online Employment Application

Employment Application

	Please complete all sections
	PERSONAL DETAILS
SURNAME (*)	Please enter your last name
GIVEN NAMES (*)	Please enter you first name(s)
ADDRESS (*)	Invalid Input
HOME PHONE	Invalid Input
MOBILE	Invalid Input
DATE OF BIRTH	Invalid Input
PLACE OF BIRTH	Invalid Input
MARITAL STATUS	Invalid Input
NUMBER OF CHILDREN	Invalid Input
	CONTACT IN EMERGENCY
NAME	Invalid Input
RELATIONSHIP	Invalid Input
ADDRESS	Invalid Input
PHONE	Invalid Input
	WORK RELATED DETAILS
QUALIFICATONS	Invalid Input
UPLOAD RESUME	Invalid Input
LIST CURRENT WORKSITE INDUCTIONS AND DATES	Invalid Input
	EMPLOYMENT HISTORY
1. COMPANY NAME AND LOCATION	Invalid Input
POSITION TITLE	Invalid Input
DUTIES (include machinery operated)	Invalid Input
DATE FROM	Invalid Input
TO	Invalid Input
CONTACT REFEREE	Invalid Input
REASON FOR LEAVING	Invalid Input
2. COMPANY NAME AND LOCATION	Invalid Input
POSITION TITLE	Invalid Input
DUTIES (include machinery operated)	Invalid Input
DATE FROM	Invalid Input
TO	Invalid Input
CONTACT REFEREE	Invalid Input
REASON FOR LEAVING	Invalid Input
3. COMPANY NAME AND LOCATION	Invalid Input
POSITION TITLE	Invalid Input
DUTIES (include machinery operated)	Invalid Input
DATE FROM	Invalid Input
TO	Invalid Input
CONTACT REFEREE	Invalid Input
REASON FOR LEAVING	Invalid Input
4. COMPANY NAME AND LOCATION	Invalid Input
POSITION TITLE	Invalid Input
DUTIES (include machinery operated)	Invalid Input
DATE FROM	Invalid Input
TO	Invalid Input
CONTACT REFEREE	Invalid Input
REASON FOR LEAVING	Invalid Input
5. COMPANY NAME AND LOCATION	Invalid Input
POSITION TITLE	Invalid Input
DUTIES (include machinery operated)	Invalid Input
DATE FROM	Invalid Input
TO	Invalid Input
CONTACT REFEREE	Invalid Input
REASON FOR LEAVING	Invalid Input
	MEDICAL HISTORY Have you ever suffered from any of the following? Give details.
Chest problems, eg: asthma, bronchitis, wheezing	YesNo Invalid Input
	Invalid Input
Persistent coughing	YesNo Invalid Input
	Invalid Input
Shortness of breath	YesNo Invalid Input
	Invalid Input
Palpitations or murmurs	YesNo Invalid Input
	Invalid Input
Angina or chest pain	YesNo Invalid Input
	Invalid Input
Heart disease	YesNo Invalid Input
	Invalid Input
High blood pressure	YesNo Invalid Input
	Invalid Input
Migraines	YesNo Invalid Input
	Invalid Input
Any allergies (include allergic reactions)	YesNo Invalid Input
	Invalid Input
Hay fever	YesNo Invalid Input
	Invalid Input
Bone disorders	YesNo Invalid Input
	Invalid Input
Back injury, pain or stiffness	YesNo Invalid Input
	Invalid Input
Neck pain or stiffness	YesNo Invalid Input
	Invalid Input
Skin problems (eg eczema, dermititis, other)	YesNo Invalid Input
	Invalid Input
Eye problems	YesNo Invalid Input
	Invalid Input
Liver problems (eg Hepatits)	YesNo Invalid Input
	Invalid Input
Diabetes	YesNo Invalid Input
	Invalid Input
Fainting attacks or blackouts	YesNo Invalid Input
	Invalid Input
Fits or epilepsy	YesNo Invalid Input
	Invalid Input
Kidney or bladder problems	YesNo Invalid Input
	Invalid Input
Hernia	YesNo Invalid Input
	Invalid Input
Hearing loss or ringing in ears	YesNo Invalid Input
	Invalid Input
HAVE YOU WORKED IN A NOISY ENVIRONMENT?	YesNo Invalid Input
HAVE YOU EVER HAD A HEARING TEST?	YesNo Invalid Input
If yes, what was the result?	Invalid Input
	ARE THERE ANY OTHER MEDICAL CONDITIONS, WHICH IN YOUR OPINION, MAY AFFECT YOUR ABILITY TO CARRY OUT ANY WORK ASSIGNED TO YOU?
	YesNo Invalid Input
If yes, please explain:	Invalid Input
	PLEASE COMPLETE THE FOLLOWING SKILLS DETAILS Include how long on each skill (ie days, weeks, months) CONSTRUCTION
Concrete shovel hand	YesNo Invalid Input
	Invalid Input
Concrete screeder	YesNo Invalid Input
	Invalid Input
Concrete finisher	YesNo Invalid Input
	Invalid Input
Concrete formworker / carpenter	YesNo Invalid Input
	Invalid Input
Concrete steel fixer	YesNo Invalid Input
	Invalid Input
Carpenter	YesNo Invalid Input
	Invalid Input
Boilermaker	YesNo Invalid Input
	Invalid Input
Brick layer	YesNo Invalid Input
	Invalid Input
Welder	YesNo Invalid Input
	Invalid Input
Block layer	YesNo Invalid Input
	Invalid Input
Fitter	YesNo Invalid Input
	Invalid Input
Cladder	YesNo Invalid Input
	Invalid Input
Painter	YesNo Invalid Input
	Invalid Input
Roofer	YesNo Invalid Input
	Invalid Input
Fencer	YesNo Invalid Input
	Invalid Input
Fabrication / Construction	YesNo Invalid Input
	Invalid Input
Other	YesNo Invalid Input
	Invalid Input
	UNDERGROUND
Jumbo operator	YesNo Invalid Input
	Invalid Input
Truck operator	YesNo Invalid Input
	Invalid Input
IT operator	YesNo Invalid Input
	Invalid Input
Loader operator	YesNo Invalid Input
	Invalid Input
Air Leg / Stoper	YesNo Invalid Input
	Invalid Input
Driller	YesNo Invalid Input
	Invalid Input
Raise driller	YesNo Invalid Input
	Invalid Input
Pipe servicing	YesNo Invalid Input
	Invalid Input
Brick waller	YesNo Invalid Input
	Invalid Input
Concreting	YesNo Invalid Input
	Invalid Input
Skippy	YesNo Invalid Input
	Invalid Input
Winder driver	YesNo Invalid Input
	Invalid Input
Other	YesNo Invalid Input
	Invalid Input
	OTHER DETAILS REQUIRED
CURRENT DRIVERS LICENSE (Must be sighted and copy uploaded with resume)	YesNo Invalid Input
LICENSE No. and CLASS	Invalid Input
FIRST AID CERTIFICATE	YesNo Invalid Input
CERTIFICATE No. and EXPIRY DATE	Invalid Input
FORKLIFT LICENSE	YesNo Invalid Input
LICENSE No.	Invalid Input
OTHER LICENSES	Invalid Input
ARE YOU A MEMBER OF A TRADE UNION?	YesNo Invalid Input
If Yes, WHAT UNION?	Invalid Input
ARE YOU CURRENTLY EMPLOYED?	YesNo Invalid Input
If Yes, indicate:	CASUALPERMANENT Invalid Input
Notice period	Invalid Input
HAVE YOU EVER BEEN CONVICTED OF A CRIMINAL OFFENCE?	YesNo Invalid Input
If Yes, please give details:	Invalid Input
	Due to policies introduced by some client companies you may be required to submit to an ‘Alcohol and Other Drugs’ testing. This requirement forms part of the terms and conditions of employment, and the results if positive, will determine your employment with Every Day Mine Services Pty Ltd. Employees are also required by some client companies to submit to regular blood lead testing. This also forms part of the terms and conditions of employment.
Are you willing to submit to: Alcohol testing	YesNo Invalid Input
Other drug testing	YesNo Invalid Input
Blood lead testing	YesNo Invalid Input
	THE FOLLOWING WORKING CONDITIONS ARE LIKELY TO BE ENCOUNTERED. ARE YOU WILLING TO WORK UNDER THEM?
WORK OVER ROUGH, UNEVEN GROUND	YesNo Invalid Input
LIFTING WEIGHTS	YesNo Invalid Input
WORK AT HEIGHTS	YesNo Invalid Input
	UNDERGROUND MINING IN AN ENVIRONMENT IN WHICH CONDITIONS MAY BE DARK, WET, CONFINED, HUMID OR OTHERWISE AFFESTED BY USE OF DIESEL EQUIPMENT?
	YesNo Invalid Input
SHIFT WORK	YesNo Invalid Input
ROSTERS	YesNo Invalid Input
SHORT NOTICE	YesNo Invalid Input
WORKING WITH INDUSTRIAL CHEMICALS	YesNo Invalid Input
	HAVE YOU RECEIVED WORKERS COMPENSATION FOR AN INDUSTRIAL ILLNESS OR INJURY? If Yes, provide details of all previous compensation claims:
	YesNo Invalid Input
1. COMPANY NAME	Invalid Input
DATE OF CLAIM	Invalid Input
INJURY	Invalid Input
2. COMPANY NAME	Invalid Input
DATE OF CLAIM	Invalid Input
INJURY	Invalid Input
3. COMPANY NAME	Invalid Input
DATE OF CLAIM	Invalid Input
INJURY	Invalid Input
(*)	I certify that the information in this application is true and correct to the best of my knowledge. Permission is hereby given to contact previous employers and referees. Invalid Input