Everyone
belongs.
  • ATTACHED DOCUMENT :
  • Resume or CV :
  • POSITION APPLIED FOR
  • DATE AVAILABLE TO COMMENCE WORK
  • PERSONAL DETAILS
  • Date Format: DD slash MM slash YYYY
  • NATIONALITY
  • EDUCATION & QUALIFICATION
    • Date Format: DD slash MM slash YYYY
    • Date Format: DD slash MM slash YYYY
    • Date Format: DD slash MM slash YYYY
    • Date Format: DD slash MM slash YYYY
  • EMPLOYMENT HISTORY
    • Date Format: DD slash MM slash YYYY
    • Date Format: DD slash MM slash YYYY
    • Date Format: DD slash MM slash YYYY
    • Date Format: DD slash MM slash YYYY
  • ADDITIONAL INFORMATION
  • EMERGENCY CONTACT
  • REFEREES
  • DRIVING
  • Date Format: DD slash MM slash YYYY
  • HEALTH
  • Are you aware of any injury, disease, disability or other condition (medical or otherwise), or is there any other reason that may*:
    • Prevent you performing the position applied for; or
    • Interfere with you fulfilling your responsibilities in that position ; or
    • Result in a risk to your health and safety, or that of others at work; or
    • That interchange should be made aware of, so that it can fulfill its own duty of care to its employees and customers; or
    • Require special workplace modifications for you to perform the position applied for, e.g. wheelchair
  • Have you ever had a Workers Compensation claim for personal injury?*
  • *Disclosure of a medical condition or restriction does not necessarily excudle an applicant from employment.
  • Section 79 of the Western Australian Worker's Compensation and Injury Management Act 1981 gives a dispute resolution body discretion to refuse to award compensation which would otherwise be payable where it is proved that the worker has, at the time of seeking or entering employment in respect of which he claims compensation for an injury, willfully and falsely represented himself as not having previously suffered from the injury.
  • DECLARATION BY APPLICANT
    • I declare that the above information and any additional information provided by me in the support of this application for the employment with interchange is correct.
    • I acknowledge that if I knowingly provide information which is untrue, this may result in a widthdrawal of any offer of employment or my employment with interchange will be reviewed with the possibility of termination.
    • I consent to any reference checks which may be necessary to support this application.
  • Date Format: DD slash MM slash YYYY

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